Provider Demographics
NPI:1174732036
Name:FABRICANT, JAMES ELIOT (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELIOT
Last Name:FABRICANT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8677 VILLA LA JOLLA DR
Mailing Address - Street 2:#1221
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:619-840-9984
Mailing Address - Fax:619-979-2083
Practice Address - Street 1:3785 N. ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-293-7031
Practice Address - Fax:520-293-7041
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AZ54152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT67103Medicare UPIN