Provider Demographics
NPI:1124341375
Name:FITZGERALD, ALICJA JANINA (OD)
Entity type:Individual
Prefix:DR
First Name:ALICJA
Middle Name:JANINA
Last Name:FITZGERALD
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 1:9845 RAMBOUILLET RDG
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-1905
Mailing Address - Country:US
Mailing Address - Phone:847-989-4983
Mailing Address - Fax:
Practice Address - Street 1:701 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6213
Practice Address - Country:US
Practice Address - Phone:920-261-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist