Provider Demographics
NPI:1225036197
Name:FISHBAUGH, MICHAEL A JR (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:FISHBAUGH
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:570 E KREMER HOYING RD STE J
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-7600
Mailing Address - Country:US
Mailing Address - Phone:419-678-8800
Mailing Address - Fax:419-678-4224
Practice Address - Street 1:570 KREMER HOYING RD.
Practice Address - Street 2:SUITE F
Practice Address - City:ST. HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-0040
Practice Address - Country:US
Practice Address - Phone:419-678-8800
Practice Address - Fax:419-678-4224
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4643/T1418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34184720300OtherST HENRY BWC
OH410046531OtherRAILROAD MEDICARE
OH000000141871OtherBC/BS
OH04072OtherPARAMOUNT HEALTHCARE
OHFI266725OtherCLARITY
OH0172343Medicaid
OH34184720301OtherDOC BWC
OH360656OtherNVA
OH410046531OtherRAILROAD MEDICARE
OH04072OtherPARAMOUNT HEALTHCARE
OHU57971Medicare UPIN
OH9314071Medicare PIN