Individual
DR. DALLAS DUSTIN FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1605 S MAIN ST, WAL-MART VISION CENTER, MARYVILLE, MO 64468-2611
(660) 562-0215
(660) 562-0217
Mailing address
19738 SUNSET RDG, SAINT JOSEPH, MO 64505-8560
(816) 662-9222
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03343
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050599111
UNITED HEALTHCARE
MO
05
—
1396716619
—
IA
01
—
25269097
BCBS
MO
05
—
313842429
—
MO
Enumeration date
01/27/2006
Last updated
05/28/2008
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