Provider Demographics
NPI:1366643926
Name:JOHN R. FISH, O.D. INC.
Entity Type:Organization
Organization Name:JOHN R. FISH, O.D. INC.
Other - Org Name:EAGLE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-458-9800
Mailing Address - Street 1:155 LITTLE CONESTOGA STREET
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:UWCHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19480
Mailing Address - Country:US
Mailing Address - Phone:610-458-9800
Mailing Address - Fax:
Practice Address - Street 1:133 LITTLE CONESTOGA RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9562
Practice Address - Country:US
Practice Address - Phone:610-458-9800
Practice Address - Fax:610-458-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00477114OtherRAILROAD MEDICARE
PA6077110001Medicare NSC
PA123757Medicare PIN