Provider Demographics
NPI:1619082997
Name:DRS. VALLO FISHER INC
Entity Type:Organization
Organization Name:DRS. VALLO FISHER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-548-4940
Mailing Address - Street 1:655 WAGNER AVE
Mailing Address - Street 2:PO BOX 629
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-548-4940
Mailing Address - Fax:937-548-1847
Practice Address - Street 1:655 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331
Practice Address - Country:US
Practice Address - Phone:937-548-4940
Practice Address - Fax:937-548-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9275251Medicare ID - Type UnspecifiedPALMETTO GBA