Provider Demographics
NPI:1427019272
Name:FITCH, JEFFREY TODD (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TODD
Last Name:FITCH
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:PO BOX 1878
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-1878
Mailing Address - Country:US
Mailing Address - Phone:406-252-5681
Mailing Address - Fax:406-252-5025
Practice Address - Street 1:1221 N 26TH STREET
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-252-5681
Practice Address - Fax:406-252-5025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0481933Medicaid
T89292Medicare UPIN