Active NPI
Dennis Ivan Fetch, O.D.,P.A
- Optometrist
- Ft Lauderdale, FL
National Provider Identifier
1992843783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1081
- Practice address
- 5200 N Federal Hwy
Suite #4
Ft Lauderdale, FL 33308-3253 - Phone
- (954) 491-6663
- Fax
- (954) 491-6697
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1081 | FL | Primary |
Addresses
Primary practice location
5200 N Federal Hwy
Suite #4
Ft Lauderdale, FL 33308-3253
Mailing address
5200 N Federal Hwy
Suite #4
Ft Lauderdale, FL 33308-3253
Phone (954) 491-6663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 650601816 | Other | FL | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1081 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1992843783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 N FEDERAL HWY",
"address_2": "SUITE #4",
"city": "FT LAUDERDALE",
"state": "FL",
"postal_code": "333083253",
"telephone_number": "954-491-6663",
"fax_number": "954-491-6697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 N FEDERAL HWY",
"address_2": "SUITE #4",
"city": "FT LAUDERDALE",
"state": "FL",
"postal_code": "333083253",
"telephone_number": "954-491-6663",
"fax_number": "954-491-6697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETCH",
"first_name": "DENNIS",
"middle_name": "IVAN",
"name_prefix": "Dr.",
"credential": "O.D.,P.A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "1081",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "650601816",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ft Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.