Provider Demographics
NPI:1508933011
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:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-235-2020
Mailing Address - Street 1:61 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MN
Mailing Address - Zip Code:56273-5005
Mailing Address - Country:US
Mailing Address - Phone:320-354-2020
Mailing Address - Fax:320-354-2019
Practice Address - Street 1:61 MAIN ST S
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-5005
Practice Address - Country:US
Practice Address - Phone:320-354-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN347472000Medicaid
MN4497850005Medicare NSC
MNC04434Medicare PIN