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Individual

DR. DENNIS IVAN FETCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.,P.A

Contact information

Practice address
5200 N FEDERAL HWY, SUITE #4, FT LAUDERDALE, FL 33308-3253
(954) 491-6663
(954) 491-6697
Mailing address
5200 N FEDERAL HWY, SUITE #4, FT LAUDERDALE, FL 33308-3253
(954) 491-6663
(954) 491-6697

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1081
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
650601816
TAX ID
FL
Enumeration date
02/02/2007
Last updated
07/09/2007
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