Organization
PATRICK FITZGERALD OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES PATRICK FITZGERALD OD (PRESIDENT)
(865) 765-1562
Entity
Organization
Contact information
Practice address
1414 PARKWAY, SEVIERVILLE, TN 37862-2845
(865) 765-1562
Mailing address
3219 TOPSIDE DR, KODAK, TN 37764-2354
(865) 765-1562
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2791
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078771000
—
FL
01
—
088
FOPN
FL
01
—
112546
EYEMED
FL
01
—
11624916
CAQH
TN
01
—
2175001
ADVANTICA
TN
01
—
63520
DAVIS VISION
TN
01
—
FE29254
OPTUM VISION SPECTERA
—
Enumeration date
03/22/2007
Last updated
12/22/2011
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