Provider Demographics
NPI:1285814558
Name:MICHAEL A. FISHBAUGH JR. O.D. INC.
Entity Type:Organization
Organization Name:MICHAEL A. FISHBAUGH JR. O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHBAUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:O D
Authorized Official - Phone:419-678-8800
Mailing Address - Street 1:570 E KREMER HOYING RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9613
Mailing Address - Country:US
Mailing Address - Phone:419-678-8800
Mailing Address - Fax:419-678-4224
Practice Address - Street 1:570 E KREMER HOYING RD
Practice Address - Street 2:
Practice Address - City:SAINT HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-9613
Practice Address - Country:US
Practice Address - Phone:419-678-8800
Practice Address - Fax:419-678-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4643 T1418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0172343Medicaid
OH410046531OtherRAILROAD MEDICARE
OH2793259Medicaid
OH410046531OtherRAILROAD MEDICARE
OH5166610001Medicare NSC
OH0172343Medicaid