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NPI Code Detail

MEDICARE: DR. JOHN MICHAEL FITZGERALD OD

MEDICARE: DR. JOHN MICHAEL FITZGERALD OD
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
1152W00000XOptometrist5387TCA

General Provider Information

NPI Number : 1801861182
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN MICHAEL FITZGERALD OD
Provider Business Mailing Address
First Line : 19000 SOLEDAD CYN RD
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91351-3362
Country : US
Telephone Number : 661-252-5111
Fax Number : 661-251-5323
Provider Business Practice Location Address
First Line : 19000 SOLEDAD CYN RD
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91351-3362
Country : US
Telephone Number : 661-252-5111
Fax Number : 661-251-5323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 07/08/2007

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