NPIMap

Organization Active NPI

David Lauren Fitzgerald OD PA

  • Optometrist
  • Plymouth, NC
National Provider Identifier
1700833175
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DAVID LAUREN FITZGERALD OD PA
Practice address
795 US Highway 64 E
Plymouth, NC 27962-9314
Phone
(252) 793-2103
Fax
(252) 793-5154
NPI assigned
May 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David L Fitzgerald, OD
Title
President
Phone
(252) 756-4204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

795 US Highway 64 E
Plymouth, NC 27962-9314

Mailing address

795 US Highway 64 E
Plymouth, NC 27962-9314
Phone (252) 793-2103

Other identifiers 2

IdentifierTypeStateIssuer
890172VMedicaidNC
0172VOtherNCBCBSNC GROUP NUMBER

Other names 1

  • Eye Care Center Doing business as

National Provider Directory

National Provider Directory

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1700833175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 US HIGHWAY 64 E",
            "city": "PLYMOUTH",
            "state": "NC",
            "postal_code": "279629314",
            "telephone_number": "252-793-2103",
            "fax_number": "252-793-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 US HIGHWAY 64 E",
            "city": "PLYMOUTH",
            "state": "NC",
            "postal_code": "279629314",
            "telephone_number": "252-793-2103",
            "fax_number": "252-793-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID LAUREN FITZGERALD OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-756-4204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890172V",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC GROUP NUMBER",
            "identifier": "0172V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.