Provider Demographics
NPI:1700833084
Name:DAVID LAUREN FITZGERALD OD PA
Entity Type:Organization
Organization Name:DAVID LAUREN FITZGERALD OD PA
Other - Org Name:EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-756-4204
Mailing Address - Street 1:1227 BRENTWAY AVE.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-7569
Mailing Address - Country:US
Mailing Address - Phone:252-792-6611
Mailing Address - Fax:252-799-0797
Practice Address - Street 1:1227 BRENTWAY AVE.
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-7569
Practice Address - Country:US
Practice Address - Phone:252-792-6611
Practice Address - Fax:252-799-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0203ROtherBCBSNC PIN
NC890203RMedicaid
NC0503980004Medicare NSC
NC2469913CMedicare PIN