Provider Demographics
NPI:1982792412
Name:FISHER, ALAN P (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:P
Last Name:FISHER
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 1:2025 E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3601
Mailing Address - Country:US
Mailing Address - Phone:863-665-4515
Mailing Address - Fax:863-665-4516
Practice Address - Street 1:2025 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3601
Practice Address - Country:US
Practice Address - Phone:863-665-4515
Practice Address - Fax:863-665-4516
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
540002113OtherRAILROAD MEDICARE
FL084841700Medicaid
FL19436OtherBCBS
FL591268685OtherTAX ID
U10328OtherDMERC
4269694OtherAETNA
FLOP1217 899OtherWORKERS COMP
FL591268685OtherTAX ID
FL19436OtherBCBS
FLOP1217 899OtherWORKERS COMP