Provider Demographics
NPI:1801861182
Name:FITZGERALD, JOHN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19000 SOLEDAD CYN RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3362
Mailing Address - Country:US
Mailing Address - Phone:661-252-5111
Mailing Address - Fax:661-251-5323
Practice Address - Street 1:19000 SOLEDAD CYN RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-3362
Practice Address - Country:US
Practice Address - Phone:661-252-5111
Practice Address - Fax:661-251-5323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5387T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist