Provider Demographics
NPI:1689738353
Name:FISHER, THOMAS EDWIN (DPO)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWIN
Last Name:FISHER
Suffix:
Gender:M
Credentials:DPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MADISON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3420
Mailing Address - Country:US
Mailing Address - Phone:901-575-9985
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3420
Practice Address - Country:US
Practice Address - Phone:901-575-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO 146156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician