Provider Demographics
NPI:1396269890
Name:FULPS, CALEN (OD)
Entity type:Individual
Prefix:
First Name:CALEN
Middle Name:
Last Name:FULPS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CALE
Other - Middle Name:
Other - Last Name:FULPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:221 S FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-7262
Mailing Address - Country:US
Mailing Address - Phone:918-341-2020
Mailing Address - Fax:
Practice Address - Street 1:221 S FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7262
Practice Address - Country:US
Practice Address - Phone:918-341-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist