Provider Demographics
NPI:1184644072
Name:FISK, JAMES (OD, PH D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FISK
Suffix:
Gender:M
Credentials:OD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4445
Mailing Address - Country:US
Mailing Address - Phone:205-978-4088
Mailing Address - Fax:205-978-4085
Practice Address - Street 1:2531 ROCKY RIDGE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-4445
Practice Address - Country:US
Practice Address - Phone:205-978-4088
Practice Address - Fax:205-978-4085
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS985TA558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2200064OtherUNITED HEALTH CARE
AL51514016OtherBLUE CROSS BLUE SHIELD
AL4691470001OtherMEDICARE PALMETTO GBA
AL2200064OtherUNITED HEALTH CARE