Individual
DR. JACKSON RILEY FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
50 E 4TH AVE, AFTON, WY 83110-5027
(307) 885-3975
Mailing address
4 S HILLSIDE DR, ELK RIDGE, UT 84651-8501
(801) 669-3687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
548T
WY
152W00000X
Optometrist
Primary
OPT-OPT-LIC-4481
MT
Other
Enumeration date
06/14/2022
Last updated
02/06/2024
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