Provider Demographics
NPI:1477034312
Name:FISCHER LASER EYE CENTER LLC
Entity Type:Organization
Organization Name:FISCHER LASER EYE CENTER LLC
Other - Org Name:FAMILY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-235-2020
Mailing Address - Street 1:1801 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4946
Mailing Address - Country:US
Mailing Address - Phone:320-235-2020
Mailing Address - Fax:
Practice Address - Street 1:629 LEGION DR STE 2
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1729
Practice Address - Country:US
Practice Address - Phone:320-321-1611
Practice Address - Fax:320-321-1612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FISCHER LASER EYE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty