Provider Demographics
NPI:1992893192
Name:FITZGERALD, AMY MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:FITZGERALD
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 1:2229 N BELT HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2481
Mailing Address - Country:US
Mailing Address - Phone:816-671-0500
Mailing Address - Fax:816-671-0600
Practice Address - Street 1:2229 N BELT HWY STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2481
Practice Address - Country:US
Practice Address - Phone:816-671-0500
Practice Address - Fax:816-671-0600
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
27265055OtherBLUECROSSBLUESHIELD
27265055OtherBLUECROSSBLUESHIELD