Provider Demographics
NPI:1669883518
Name:DAVID LAUREN FITZGERALD OD PA
Entity type:Organization
Organization Name:DAVID LAUREN FITZGERALD OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-756-4204
Mailing Address - Street 1:105 E GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-6753
Mailing Address - Country:US
Mailing Address - Phone:252-974-3381
Mailing Address - Fax:252-794-3371
Practice Address - Street 1:105 E GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6753
Practice Address - Country:US
Practice Address - Phone:252-974-3381
Practice Address - Fax:252-794-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty