Provider Demographics
NPI:1659460186
Name:FISCHER, LAURA J (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:FISCHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:RENCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0922
Mailing Address - Country:US
Mailing Address - Phone:509-879-8376
Mailing Address - Fax:
Practice Address - Street 1:22106 E COUNTRY VISTA DR
Practice Address - Street 2:SUITE A
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6017
Practice Address - Country:US
Practice Address - Phone:509-927-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3973152W00000X
IDODP-100181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01735Medicare UPIN