Provider Demographics
NPI:1720535263
Name:FISCHER VISION PC
Entity Type:Organization
Organization Name:FISCHER VISION PC
Other - Org Name:NORTH STAR EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LONDA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:FISCHER COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-212-0500
Mailing Address - Street 1:21 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1318
Mailing Address - Country:US
Mailing Address - Phone:320-212-0500
Mailing Address - Fax:
Practice Address - Street 1:13334 BASS LAKE ROAD NORTH
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311
Practice Address - Country:US
Practice Address - Phone:320-212-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty