Provider Demographics
NPI:1033100417
Name:DR EDWARD H FICTCH OPTOMETRY INC
Entity Type:Organization
Organization Name:DR EDWARD H FICTCH OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-548-0505
Mailing Address - Street 1:27 FALMOUTH HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3660
Mailing Address - Country:US
Mailing Address - Phone:508-548-0505
Mailing Address - Fax:508-548-0382
Practice Address - Street 1:27 FALMOUTH HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3660
Practice Address - Country:US
Practice Address - Phone:508-548-0505
Practice Address - Fax:508-548-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
544115OtherAETNA/ US HEALTHCARE
805604OtherTUFTS
MA9768106Medicaid
0538750001OtherDMERC
W20013OtherBCBS
805604OtherTUFTS