Provider Demographics
NPI:1922028653
Name:FISHER, SVETLANA (OD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7976 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5109
Mailing Address - Country:US
Mailing Address - Phone:323-650-0988
Mailing Address - Fax:323-650-1579
Practice Address - Street 1:7976 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5109
Practice Address - Country:US
Practice Address - Phone:323-650-0988
Practice Address - Fax:323-650-1579
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9936T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU37792Medicare UPIN