Organization
DAVID LAUREN FITZGERALD OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L FITZGERALD OD (OWNER)
(252) 756-4204
Entity
Organization
Contact information
Practice address
3450 S CONTENTNEA ST, FARMVILLE, NC 27828-1686
(252) 753-3325
(252) 753-2057
Mailing address
3450 S CONTENTNEA ST, FARMVILLE, NC 27828-1686
(252) 753-3325
(252) 753-2057
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1408
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0250Q
BCBS
NC
01
—
0455290001
DMERC
—
01
—
562054972
CHAMPUS
NC
05
—
890250Q
—
NC
Enumeration date
05/02/2006
Last updated
06/25/2015
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