Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG003562 | PA |
NPI | 1003478314 |
---|---|
Provider Name | Julia Fitzpatrick |
First Address | Amarillo, TX 79106-1990 |
Second Address | Amarillo, TX 79106-1990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2019 |
Last Update Date | 05/09/2019 |