Provider Demographics
NPI:1225314909
Name:KENNETH FISCHER, OD INC.
Entity Type:Organization
Organization Name:KENNETH FISCHER, OD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:808-885-4000
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:MSC 61219
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-885-4000
Mailing Address - Fax:
Practice Address - Street 1:65-1227B OPELO RD STE 5
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8443
Practice Address - Country:US
Practice Address - Phone:808-885-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH0000PCBMHMedicare PIN