Healthcare Provider Details

I. General information

NPI: 1851359566
Provider Name (Legal Business Name): DAVID LAUREN FITZGERALD OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 S CONTENTNEA ST
FARMVILLE NC
27828-1686
US

IV. Provider business mailing address

3450 S CONTENTNEA ST
FARMVILLE NC
27828-1686
US

V. Phone/Fax

Practice location:
  • Phone: 252-753-3325
  • Fax: 252-753-2057
Mailing address:
  • Phone: 252-753-3325
  • Fax: 252-753-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1408
License Number StateNC

VIII. Authorized Official

Name: DR. DAVID L FITZGERALD
Title or Position: OWNER
Credential: OD
Phone: 252-756-4204