Provider Demographics
NPI:1144267105
Name:FITZGERALD, DAVID LAUREN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAUREN
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:215 LAUCHWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4647
Practice Address - Country:US
Practice Address - Phone:910-276-1993
Practice Address - Fax:910-462-3081
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001274152W00000X
NC1363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0935GOtherBCBS INDIVIDUAL NUMBER
NC890935GMedicaid
NC2467429NMedicare PIN
NC890935GMedicaid
NC410041841Medicare PIN
NC0935GOtherBCBS INDIVIDUAL NUMBER