Provider Demographics
NPI:1134226822
Name:FITZSIMMONS, DENNIS JOHN (OD)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JOHN
Last Name:FITZSIMMONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 NORTH STRIKLER ROAD
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545
Mailing Address - Country:US
Mailing Address - Phone:717-653-9331
Mailing Address - Fax:
Practice Address - Street 1:2034 LINCOLN HIGHWAY EAST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602
Practice Address - Country:US
Practice Address - Phone:717-390-8784
Practice Address - Fax:717-390-9085
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0E006089P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01923090Medicaid
PA921366OtherBLOCKVISION
PA42370OtherDAVIS
T30427Medicare UPIN
PA01923090Medicaid