Provider Demographics
NPI:1265586911
Name:FISHER, SUSAN HARRISON (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HARRISON
Last Name:FISHER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:HARRISON
Other - Last Name:HOUNSHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPTICIAN
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:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001358156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician