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General NPI Number Information
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NPI Number | 1992876858
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Entity Type | Individual
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Provider Name | THOMAS C FITZGERALD O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3167 S STATE ROAD 3
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City | NEW CASTLE
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State | IN
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Zip | 47362-1318
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Country | US
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Telephone | 765-597-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 6140 CHADWORTH WAY
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City | INDIANAPOLIS
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State | IN
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Zip | 46236-8291
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Country | US
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Telephone | 317-826-0138
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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 | 18002815B
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License Number State | IN
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