Provider Demographics
NPI:1275595134
Name:FISHER, RONALD DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DEAN
Last Name:FISHER
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 1:2635 W DOUGLAS
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213
Mailing Address - Country:US
Mailing Address - Phone:316-942-7496
Mailing Address - Fax:316-942-9431
Practice Address - Street 1:2635 W DOUGLAS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213
Practice Address - Country:US
Practice Address - Phone:316-942-7496
Practice Address - Fax:316-942-9431
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650890Medicare PIN
T43627Medicare UPIN