Provider Demographics
NPI:1831435882
Name:JOHN P. FITZPATRICK, O.D., A.P.C
Entity type:Organization
Organization Name:JOHN P. FITZPATRICK, O.D., A.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-729-5921
Mailing Address - Street 1:3044 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2320
Mailing Address - Country:US
Mailing Address - Phone:760-729-5921
Mailing Address - Fax:760-729-4369
Practice Address - Street 1:3044 HARDING ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2320
Practice Address - Country:US
Practice Address - Phone:760-729-5921
Practice Address - Fax:760-729-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8185TPA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP8185Medicare PIN
CAU28636Medicare UPIN