Provider Demographics
NPI:1316019391
Name:FISCHMAN, DANIEL I (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:I
Last Name:FISCHMAN
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 1:14A JAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2804
Mailing Address - Country:US
Mailing Address - Phone:631-475-0222
Mailing Address - Fax:631-475-0586
Practice Address - Street 1:14-A JAYNE AVENUE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-475-0222
Practice Address - Fax:631-475-0586
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT-005108-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist