Provider Demographics
NPI:1194835520
Name:FISHER, BRANDON RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:RAY
Last Name:FISHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:746 N MAIZE RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212
Mailing Address - Country:US
Mailing Address - Phone:316-721-8877
Mailing Address - Fax:316-721-6762
Practice Address - Street 1:746 N MAIZE RD
Practice Address - Street 2:SUITE #100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4502
Practice Address - Country:US
Practice Address - Phone:316-721-8877
Practice Address - Fax:316-721-6762
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist