Healthcare Provider Details

I. General information

NPI: 1548423866
Provider Name (Legal Business Name): DR FITZGERALD & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WILLIAMS PKWY SW STE 1
CEDAR RAPIDS IA
52404-1476
US

IV. Provider business mailing address

3225 WILLIAMS PKWY SW STE 1
CEDAR RAPIDS IA
52404-1476
US

V. Phone/Fax

Practice location:
  • Phone: 319-366-3500
  • Fax:
Mailing address:
  • Phone: 319-366-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number01818
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number01818
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number01818
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number01818
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number01818
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number01818
License Number StateIA
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number01818
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3015248
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier24711
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BCBS

VIII. Authorized Official

Name: DR. DEANN MARIE FITZGERALD
Title or Position: OWNER
Credential: OPTOMETRIST
Phone: 319-366-3500