Provider Demographics
NPI:1770347569
Name:FISCHER, MARK RICHARD (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:FISCHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N SABINO CANYON RD UNIT 22
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6134
Mailing Address - Country:US
Mailing Address - Phone:563-451-7436
Mailing Address - Fax:
Practice Address - Street 1:440 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1958
Practice Address - Country:US
Practice Address - Phone:520-327-6211
Practice Address - Fax:314-741-4947
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ002768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program