Provider Demographics
NPI:1558310623
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/SURGEON
Authorized Official - Prefix:MR
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 1:1801 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:320-214-5761
Practice Address - Street 1:1801 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4946
Practice Address - Country:US
Practice Address - Phone:320-235-2020
Practice Address - Fax:320-214-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5545930152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03116OtherMEDICARE PTAN
MNCJ8506OtherRAILROAD MEDICARE
MN703716300Medicaid
MN703716300Medicaid