Healthcare Provider Details

I. General information

NPI: 1942529714
Provider Name (Legal Business Name): CRAIG A FIDLER OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S FEDERAL HWY
FORT LAUDERDALE FL
33316-3545
US

IV. Provider business mailing address

2120 S FEDERAL HWY
FORT LAUDERDALE FL
33316-3545
US

V. Phone/Fax

Practice location:
  • Phone: 954-467-3777
  • Fax: 954-463-7643
Mailing address:
  • Phone: 954-467-3777
  • Fax: 954-463-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOPC1638
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1638
License Number StateFL

VIII. Authorized Official

Name: DR. CRAIG ALLEN FIDLER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 954-467-3777