Provider Demographics
NPI:1336229855
Name:FITZGERALD, JAMES P (OD PA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
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Mailing Address - Street 1:3219 TOPSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-2354
Mailing Address - Country:US
Mailing Address - Phone:865-765-1562
Mailing Address - Fax:865-465-3866
Practice Address - Street 1:1414 PARKWAY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-2845
Practice Address - Country:US
Practice Address - Phone:865-765-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2791152W00000X
FL1530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650844073OtherVSP
FL078771000Medicaid
FL088OtherFOPN
TN63520OtherDAVIS VISION
TN650844073OtherBCBSTN
FL29254OtherSPECTERA
TNFE29254OtherOPTUM VISION SPECTERA
FL112546OtherEYEMED
650844073OtherSUPERIOR VISION
FL4836790001Medicare NSC
TN63520OtherDAVIS VISION
FL29254OtherSPECTERA