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General NPI Number Information
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NPI Number | 1114938727
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Entity Type | Organization
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Legal Business Name | FITZGERALD FAMILY EYECARE, P.C.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 1329 OCILLA RD
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City | DOUGLAS
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State | GA
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Zip | 31533-2213
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Country | US
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Telephone | 912-393-0005
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Fax | 912-393-0058
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Provider Business Mailing Address
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Address Line | 1329 OCILLA RD
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City | DOUGLAS
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State | GA
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Zip | 31533-2213
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Country | US
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Telephone | 912-393-0005
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Fax | 912-393-0058
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLEN DRURY FITZGERALD
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Credential | O.D.
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Telephone | 912-393-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002104
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License Number State | GA
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