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General NPI Number Information
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NPI Number | 1760889232
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Entity Type | Organization
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Legal Business Name | PHILLIP N FITCH OD PC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 603 E MAIN ST
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City | ANAMOSA
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State | IA
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Zip | 52205-1845
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Country | US
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Telephone | 319-462-4891
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Fax | 319-462-4892
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Provider Business Mailing Address
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Address Line | 603 E MAIN ST
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City | ANAMOSA
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State | IA
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Zip | 52205-1845
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Country | US
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Telephone | 319-462-4891
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Fax | 319-462-4892
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP N FITCH
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Credential | OD
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Telephone | 319-462-4891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 002491
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002491
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License Number State | IA
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