Individual
DR. J.E.B. FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
825 FISHBURN RD, HERSHEY, PA 17033-2015
(717) 533-5200
(717) 533-2606
Mailing address
825 FISHBURN RD, HERSHEY, PA 17033-2015
(717) 533-5200
(717) 533-2606
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001821
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102057079002
—
PA
01
—
558206
BLUE SHIELD
PA
01
—
ID001997161
HIGHMARK BS
PA
01
—
P00733848
RAILROAD MEDICARE
PA
Enumeration date
11/21/2006
Last updated
09/18/2014
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