Provider Demographics
NPI:1356416713
Name:DR SVETLANA FISHER AN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:DR SVETLANA FISHER AN OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-650-0988
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 1:21001 SHERMAN WAY STE 14
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3679
Practice Address - Country:US
Practice Address - Phone:747-230-4024
Practice Address - Fax:818-276-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9936TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD003081Medicaid
CAWY141Medicare PIN