Provider Demographics
NPI:1740293919
Name:FITCH, JAMES (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FITCH
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 1:8601 SW 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6565
Mailing Address - Country:US
Mailing Address - Phone:806-355-4407
Mailing Address - Fax:806-355-5855
Practice Address - Street 1:8601 SW 45TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6565
Practice Address - Country:US
Practice Address - Phone:806-355-4407
Practice Address - Fax:806-355-5855
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04463TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042042401Medicaid
TX83400EMedicare PIN
TXU21028Medicare UPIN