Provider Demographics
NPI:1578547469
Name:FISHER, DAVID CLARENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARENCE
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 1:10502 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6528
Mailing Address - Country:US
Mailing Address - Phone:714-776-2020
Mailing Address - Fax:
Practice Address - Street 1:10502 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6528
Practice Address - Country:US
Practice Address - Phone:714-776-2020
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9240T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist