Provider Demographics
NPI:1619958428
Name:FITZGERALD, DEANN M (OD)
Entity Type:Individual
Prefix:DR
First Name:DEANN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 WILLIAMS PKWY SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1476
Mailing Address - Country:US
Mailing Address - Phone:319-366-3500
Mailing Address - Fax:319-366-4116
Practice Address - Street 1:3225 WILLIAMS PKWY SW
Practice Address - Street 2:SUITE 1
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1476
Practice Address - Country:US
Practice Address - Phone:319-366-3500
Practice Address - Fax:319-366-4116
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3015248Medicaid
T01410Medicare UPIN
IA24711Medicare PIN
IA3015248Medicaid
IA5026240001Medicare NSC