Provider Demographics
NPI:1891884771
Name:FISHER, MICHAEL BRANDON (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRANDON
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 1:230 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1411
Mailing Address - Country:US
Mailing Address - Phone:312-969-1978
Mailing Address - Fax:
Practice Address - Street 1:230 10TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1411
Practice Address - Country:US
Practice Address - Phone:507-831-3478
Practice Address - Fax:507-831-3479
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3018152W00000X
IL046009830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist