Provider Demographics
NPI:1497762769
Name:FITZHUGH, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:FITZHUGH
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 1:3013 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE #400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3953
Mailing Address - Country:US
Mailing Address - Phone:972-208-5100
Mailing Address - Fax:972-208-5103
Practice Address - Street 1:3013 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE #400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-3953
Practice Address - Country:US
Practice Address - Phone:972-208-5100
Practice Address - Fax:972-208-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2707TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E82KOtherBC/BS
TX20120OtherCIGNA
TX4392135OtherAETNA
T13275Medicare UPIN
T13275Medicare PIN
TX4392135OtherAETNA