MEDICARE: DAVID LAUREN FITZGERALD OD PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0922U	OTHER	NC	BCBSNC GROUP NUMBER

General Provider Information

NPI Number	:	1679520852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID LAUREN FITZGERALD OD PA

Provider Business Mailing Address
First Line	:	5100 HWY 70 W
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4504
Country	:	US
Telephone Number	:	252-727-5290
Fax Number	:	252-727-0091

Provider Business Practice Location Address
First Line	:	5100 HWY 70 W
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4504
Country	:	US
Telephone Number	:	252-727-5290
Fax Number	:	252-727-0091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID L FITZGERALD
Credential	:	OD
Telephone Number	:	252-756-4204

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/18/2008

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