Provider Demographics
NPI:1982639159
Name:FRITCH, CHARLES DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:FRITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 BRIMHALL RD
Mailing Address - Street 2:402
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2257
Mailing Address - Country:US
Mailing Address - Phone:661-665-2020
Mailing Address - Fax:661-829-6990
Practice Address - Street 1:8501 BRIMHALL RD
Practice Address - Street 2:402
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2257
Practice Address - Country:US
Practice Address - Phone:661-665-2020
Practice Address - Fax:661-829-6990
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33729207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770338461OtherTAX ID
CA770338461OtherTAX ID
CAA35365Medicare UPIN
CA0698410002Medicare NSC