Provider Demographics
NPI:1497758775
Name:FISCHER, BETH L (OD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:FISCHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 W ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2218
Mailing Address - Country:US
Mailing Address - Phone:218-728-6211
Mailing Address - Fax:
Practice Address - Street 1:1344 W ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2218
Practice Address - Country:US
Practice Address - Phone:218-728-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2810152W00000X
WI3025-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410045434OtherRAILROAD MEDICARE
MN5100031300Medicaid
MN22-01339OtherMEDICA
MN76B36FIOtherBCBS
MN5100031300Medicaid
MN410045434OtherRAILROAD MEDICARE