Provider Demographics
NPI:1821058041
Name:FITCH, STACY K (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:K
Last Name:FITCH
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 1:2144 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2554
Mailing Address - Country:US
Mailing Address - Phone:785-266-1010
Mailing Address - Fax:785-266-5312
Practice Address - Street 1:2144 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2554
Practice Address - Country:US
Practice Address - Phone:785-266-1010
Practice Address - Fax:785-266-5312
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1301-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST91577Medicare UPIN
KS049711Medicare ID - Type Unspecified
KS0721960001Medicare NSC