=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164653119
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHERINE M FIEDLER OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2009
-----------------------------------------------------
Last Update Date | 08/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 E ATLANTIC AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33483-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-263-8649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 169 MULBERRY GROVE RD
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-263-8649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OPTOMETRIST
-----------------------------------------------------
Name | DR. CATHERINE M FIEDLER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 954-263-8649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC3582
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------