=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740307891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD L FITCH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 02/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 N STATE ST
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-0315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-968-2330
-----------------------------------------------------
Fax | 215-968-2330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 315 119 N STATE ST
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-0315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-968-2330
-----------------------------------------------------
Fax | 215-968-2330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DONALD L FITCH
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 215-968-2330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001428
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------