Provider Demographics
NPI:1851827596
Name:FITZGERALD, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 PRESIDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5714
Mailing Address - Country:US
Mailing Address - Phone:330-360-3779
Mailing Address - Fax:330-953-3635
Practice Address - Street 1:777 PRESIDENTIAL DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5714
Practice Address - Country:US
Practice Address - Phone:330-360-3779
Practice Address - Fax:330-953-3635
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC6056156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician