Provider Demographics
NPI:1710060520
Name:FISCHER, CHARLES KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENNETH
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ST. MARY'S DRIVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-479-8222
Mailing Address - Fax:812-479-9501
Practice Address - Street 1:801 ST. MARY'S DRIVE
Practice Address - Street 2:SUITE 504
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-479-8222
Practice Address - Fax:812-479-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024567A207W00000X
MOR4071207W00000X
GA011329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000042313OtherANTHEM BC
IN126828OtherHEALTHLINK
IN131381OtherCSHCS
IN131381OtherCSHCS
INC25836Medicare UPIN