Provider Demographics
NPI:1700833175
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 1:795 US HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9314
Mailing Address - Country:US
Mailing Address - Phone:252-793-2103
Mailing Address - Fax:252-793-5154
Practice Address - Street 1:795 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9314
Practice Address - Country:US
Practice Address - Phone:252-793-2103
Practice Address - Fax:252-793-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890172VMedicaid
NC0172VOtherBCBSNC GROUP NUMBER
NC0503980003Medicare NSC
NC0172VOtherBCBSNC GROUP NUMBER