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NPI Code Detail

MEDICARE: JENNIFER FULTZ FITZGERALD O.D.

MEDICARE:   JENNIFER FULTZ FITZGERALD  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4558T1301OH

General Provider Information

NPI Number : 1740346519
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER FULTZ FITZGERALD O.D.
Provider Business Mailing Address
First Line : 5167 REDDINGTON DR
Second Line :
City : DUBLIN
State : OH
Zip : 43017-8727
Country : US
Telephone Number : 614-565-0159
Fax Number :
Provider Business Practice Location Address
First Line : 555 COLEMANS XING
Second Line :
City : MARYSVILLE
State : OH
Zip : 43040-7042
Country : US
Telephone Number : 937-642-9495
Fax Number : 937-642-4590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2006
Last Update Date : 02/26/2016

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Directions to “ JENNIFER FULTZ FITZGERALD O.D.” Practice Location

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