Provider Demographics
NPI:1003836883
Name:FITT, DONNA M (OD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:FITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1301
Mailing Address - Country:US
Mailing Address - Phone:610-941-4149
Mailing Address - Fax:610-941-8144
Practice Address - Street 1:421 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1301
Practice Address - Country:US
Practice Address - Phone:610-941-4149
Practice Address - Fax:610-941-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-006240T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
180100Medicare ID - Type UnspecifiedMEDICARE ID NUMBER