Provider Demographics
NPI:1619257052
Name:CHARLES D. FRITCH, M.D., INC.
Entity Type:Organization
Organization Name:CHARLES D. FRITCH, M.D., INC.
Other - Org Name:BRIMHALL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-665-2020
Mailing Address - Street 1:9500 BRIMHALL RD
Mailing Address - Street 2:703
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2241
Mailing Address - Country:US
Mailing Address - Phone:661-829-6993
Mailing Address - Fax:661-829-6995
Practice Address - Street 1:9500 BRIMHALL RD
Practice Address - Street 2:703
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2241
Practice Address - Country:US
Practice Address - Phone:661-829-6993
Practice Address - Fax:661-829-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0116921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty