Provider Demographics
NPI:1114649571
Name:FISCHER PEDIATRIC OPTOMETRY, PA
Entity Type:Organization
Organization Name:FISCHER PEDIATRIC OPTOMETRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:SABRINA
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-225-1145
Mailing Address - Street 1:8220 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2028
Mailing Address - Country:US
Mailing Address - Phone:305-225-1145
Mailing Address - Fax:
Practice Address - Street 1:8220 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2028
Practice Address - Country:US
Practice Address - Phone:305-225-1145
Practice Address - Fax:305-225-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621108900Medicaid