Provider Demographics
NPI:1770584567
Name:FISHEL, JENNIFER (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FISHEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:FISHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2010 BREMO RD STE 128A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2444
Mailing Address - Country:US
Mailing Address - Phone:877-969-0392
Mailing Address - Fax:
Practice Address - Street 1:3185 W STATE ST STE 2010
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1600
Practice Address - Country:US
Practice Address - Phone:423-968-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1791152W00000X
TN3779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA5231OtherMEDCOST PROVIDER ID
NC093A7OtherBLUE CROSS PROVIDER ID
NC2256806OtherUNITED HEALTH CARE ID
NC89093A7Medicaid
NC89093A7Medicaid
NC093A7OtherBLUE CROSS PROVIDER ID
NC1029650001Medicare NSC
NC2471796AMedicare PIN