MEDICARE: DAVID L FITZHUGH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2707TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	2707TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00E82K	OTHER	TX	BC/BS
2	20120	OTHER	TX	CIGNA
3	4392135	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1497762769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L FITZHUGH O.D.

Provider Business Mailing Address
First Line	:	3013 W SPRING CREEK PKWY
Second Line	:	SUITE #400
City	:	PLANO
State	:	TX
Zip	:	75023-3953
Country	:	US
Telephone Number	:	972-208-5100
Fax Number	:	972-208-5103

Provider Business Practice Location Address
First Line	:	3013 W SPRING CREEK PKWY
Second Line	:	SUITE #400
City	:	PLANO
State	:	TX
Zip	:	75023-3953
Country	:	US
Telephone Number	:	972-208-5100
Fax Number	:	972-208-5103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/22/2008

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Directions to “ DAVID L FITZHUGH O.D.” Practice Location

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