Provider Demographics
NPI:1851557177
Name:ROBERT C. FITZHUGH,O.D.,PA, INC
Entity Type:Organization
Organization Name:ROBERT C. FITZHUGH,O.D.,PA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FITZHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-533-4027
Mailing Address - Street 1:P.O.BOX 38
Mailing Address - Street 2:
Mailing Address - City:STAMPS
Mailing Address - State:AR
Mailing Address - Zip Code:71860
Mailing Address - Country:US
Mailing Address - Phone:870-533-4027
Mailing Address - Fax:
Practice Address - Street 1:210 THOMAS ST
Practice Address - Street 2:
Practice Address - City:STAMPS
Practice Address - State:AR
Practice Address - Zip Code:71860
Practice Address - Country:US
Practice Address - Phone:870-533-4027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6243820001Medicare NSC