Provider Demographics
NPI:1154639201
Name:FISCHER, JOSEPH LEONARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEONARD
Last Name:FISCHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 4J CT
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4135
Mailing Address - Country:US
Mailing Address - Phone:307-682-2020
Mailing Address - Fax:307-682-5656
Practice Address - Street 1:609 4J CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4135
Practice Address - Country:US
Practice Address - Phone:307-682-2020
Practice Address - Fax:307-682-5656
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY331T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist