Healthcare Provider Details

I. General information

NPI: 1700833175
Provider Name (Legal Business Name): DAVID LAUREN FITZGERALD OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 US HIGHWAY 64 E
PLYMOUTH NC
27962-9314
US

IV. Provider business mailing address

795 US HIGHWAY 64 E
PLYMOUTH NC
27962-9314
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-2103
  • Fax: 252-793-5154
Mailing address:
  • Phone: 252-793-2103
  • Fax: 252-793-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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