Provider Demographics
NPI:1881792844
Name:FISH, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 750
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2727
Mailing Address - Country:US
Mailing Address - Phone:713-524-3434
Mailing Address - Fax:713-524-3220
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 750
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2727
Practice Address - Country:US
Practice Address - Phone:713-524-3434
Practice Address - Fax:713-524-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0344207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10015218OtherAMERIVANTAGE
TX134386502Medicaid
TX134386503Medicaid
TX23020OtherTEXAN PLUS-SELECTCARE
TX23020OtherSELECTCARE
TXE79918OtherSTERLING OPTION
LA1651842Medicaid
TX19317OtherOPTICARE
TX4262043OtherAETNA
TX10015218OtherAMERIGROUP
TX80G065OtherBLUE SHIELD
LA1651842Medicaid
TX87H589Medicare PIN
TX80G065OtherBLUE SHIELD
TX19317OtherOPTICARE
TX23020OtherSELECTCARE
TX10015218OtherAMERIVANTAGE