Provider Demographics
NPI:1841551132
Name:MICHELLE FITZPATRICK INC
Entity type:Organization
Organization Name:MICHELLE FITZPATRICK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-233-6183
Mailing Address - Street 1:1947 FERN ST
Mailing Address - Street 2:#3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1137
Mailing Address - Country:US
Mailing Address - Phone:619-233-6183
Mailing Address - Fax:619-232-7415
Practice Address - Street 1:1947 FERN ST
Practice Address - Street 2:#3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1137
Practice Address - Country:US
Practice Address - Phone:619-233-6183
Practice Address - Fax:619-232-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13428T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGD219AMedicare PIN