Provider Demographics
NPI:1861605552
Name:FECHTER, GEORGE LEONARD (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEONARD
Last Name:FECHTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9534 LIVINGSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FT WASH
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:301-248-2700
Mailing Address - Fax:301-248-6078
Practice Address - Street 1:9534 LIVINGSTON ROAD
Practice Address - Street 2:
Practice Address - City:FT WASH
Practice Address - State:MD
Practice Address - Zip Code:20744
Practice Address - Country:US
Practice Address - Phone:301-248-2700
Practice Address - Fax:301-248-6078
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW8559Medicare UPIN