Provider Demographics
NPI:1700960028
Name:GERALD H FISHER & ERIKA L FISHER, PA
Entity Type:Organization
Organization Name:GERALD H FISHER & ERIKA L FISHER, PA
Other - Org Name:COMPLETE FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-287-4567
Mailing Address - Street 1:651 STATE ROAD 13
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2830
Mailing Address - Country:US
Mailing Address - Phone:904-287-4567
Mailing Address - Fax:904-287-4597
Practice Address - Street 1:651 STATE ROAD 13
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-2830
Practice Address - Country:US
Practice Address - Phone:904-287-4567
Practice Address - Fax:904-287-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5294080001Medicare NSC
FLK5903Medicare PIN