Provider Demographics
NPI:1356330278
Name:FITZPATRICK, JON E (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:E
Last Name:FITZPATRICK
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 1:2655 CLEVELAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2779
Mailing Address - Country:US
Mailing Address - Phone:707-545-7350
Mailing Address - Fax:707-546-7787
Practice Address - Street 1:2655 CLEVELAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2779
Practice Address - Country:US
Practice Address - Phone:707-545-7350
Practice Address - Fax:707-546-7787
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7949T152WC0802X
CACA 7949T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU27941Medicare UPIN