Provider Demographics
NPI:1205228988
Name:FISHER EYE CARE CLINIC, L.L.C.
Entity Type:Organization
Organization Name:FISHER EYE CARE CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-831-3478
Mailing Address - Street 1:230 10TH ST
Mailing Address - Street 2:P.O. BOX 457
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1411
Mailing Address - Country:US
Mailing Address - Phone:507-831-3478
Mailing Address - Fax:507-831-3479
Practice Address - Street 1:230 10TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1411
Practice Address - Country:US
Practice Address - Phone:507-831-3478
Practice Address - Fax:507-831-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty