Provider Demographics
NPI:1194106807
Name:FETZER, BAILEY CATHERINE (OD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:CATHERINE
Last Name:FETZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:CATHERINE
Other - Last Name:DEGLOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:173 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1802
Mailing Address - Country:US
Mailing Address - Phone:212-627-4488
Mailing Address - Fax:212-627-4489
Practice Address - Street 1:173 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1802
Practice Address - Country:US
Practice Address - Phone:212-627-4488
Practice Address - Fax:212-627-4489
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist