Provider Demographics
NPI:1104016377
Name:FISCHER LASER EYE CENTER, LLC
Entity Type:Organization
Organization Name:FISCHER LASER EYE CENTER, LLC
Other - Org Name:FAMILY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-235-2020
Mailing Address - Street 1:715 N SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-1765
Mailing Address - Country:US
Mailing Address - Phone:320-593-2020
Mailing Address - Fax:320-593-0402
Practice Address - Street 1:715 N SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-1765
Practice Address - Country:US
Practice Address - Phone:320-593-2020
Practice Address - Fax:320-593-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5545930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04650Medicare PIN
MN4497850006Medicare NSC