Provider Demographics
NPI:1760536429
Name:FISHER, DOUGLAS POWELL JR (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:POWELL
Last Name:FISHER
Suffix:JR
Gender:M
Credentials:OPTICIAN
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Mailing Address - Street 1:1980 SOUTH SYCAMORE STREET
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2729
Mailing Address - Country:US
Mailing Address - Phone:804-861-3005
Mailing Address - Fax:804-861-8243
Practice Address - Street 1:1980 SOUTH SYCAMORE STREET
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2729
Practice Address - Country:US
Practice Address - Phone:804-861-3005
Practice Address - Fax:804-861-8243
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1101001155156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician