Provider Demographics
NPI:1821252461
Name:FISHER, JEFFREY WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:FISHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 YARDLEY WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1215
Mailing Address - Country:US
Mailing Address - Phone:813-968-2740
Mailing Address - Fax:813-968-2750
Practice Address - Street 1:6192 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4014
Practice Address - Country:US
Practice Address - Phone:813-968-2740
Practice Address - Fax:813-968-2750
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3793152WC0802X
FLOPC3793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT32593Medicare UPIN