Provider Demographics
NPI:1588655237
Name:FISHER, HERBERT A (OD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:A
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 1:3121 N REYNOLDS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9190
Mailing Address - Country:US
Mailing Address - Phone:501-653-2288
Mailing Address - Fax:501-653-2404
Practice Address - Street 1:3121 N REYNOLDS RD STE 4
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9190
Practice Address - Country:US
Practice Address - Phone:501-653-2288
Practice Address - Fax:501-653-2404
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104318722Medicaid
AR826540193OtherMEDICARE RAILROAD
AR104318722Medicaid
AR48789Medicare ID - Type Unspecified
AR0201750001Medicare NSC