Provider Demographics
NPI:1669532040
Name:FISHER FOODS MARKETING INC
Entity type:Organization
Organization Name:FISHER FOODS MARKETING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DUERR
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:330-497-0205
Mailing Address - Street 1:4855 FRANK ROAD NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7425
Mailing Address - Country:US
Mailing Address - Phone:330-497-0205
Mailing Address - Fax:330-497-1142
Practice Address - Street 1:8100 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5664
Practice Address - Country:US
Practice Address - Phone:330-433-1180
Practice Address - Fax:330-305-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH801S332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412960004Medicare NSC