Provider Demographics
NPI:1093062325
Name:FISHER, KATIE DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:DAWN
Last Name:FISHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6342 LONG AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2513
Mailing Address - Country:US
Mailing Address - Phone:913-631-0262
Mailing Address - Fax:913-631-0266
Practice Address - Street 1:12621 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1701
Practice Address - Country:US
Practice Address - Phone:913-814-7707
Practice Address - Fax:913-814-7997
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1914152W00000X
MO2013021002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist