Provider Demographics
NPI:1760889232
Name:PHILLIP N FITCH OD PC
Entity Type:Organization
Organization Name:PHILLIP N FITCH OD PC
Other - Org Name:SIGMA EYEHEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-462-4891
Mailing Address - Street 1:603 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1845
Mailing Address - Country:US
Mailing Address - Phone:319-462-4891
Mailing Address - Fax:319-462-4892
Practice Address - Street 1:603 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1845
Practice Address - Country:US
Practice Address - Phone:319-462-4891
Practice Address - Fax:319-462-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002491152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty