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General NPI Number Information
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NPI Number | 1124341375
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Entity Type | Individual
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Provider Name | ALICJA JANINA FITZGERALD O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 701 S CHURCH ST
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City | WATERTOWN
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State | WI
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Zip | 53094-6213
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Country | US
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Telephone | 920-261-9225
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Fax |
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Provider Business Mailing Address
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Address Line | 9845 RAMBOUILLET RDG
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City | ROSCOE
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State | IL
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Zip | 61073-1905
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Country | US
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Telephone | 847-989-4983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046.010309
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License Number State | IL
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