Provider Demographics
NPI:1518049840
Name:FISHER, GERALD H (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:H
Last Name:FISHER
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 1:100 STATE ROAD 13 STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3839
Mailing Address - Country:US
Mailing Address - Phone:904-287-4567
Mailing Address - Fax:904-287-4597
Practice Address - Street 1:100 STATE ROAD 13 STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3839
Practice Address - Country:US
Practice Address - Phone:904-287-4567
Practice Address - Fax:904-287-4597
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV00346Medicare UPIN