Healthcare Provider Details

I. General information

NPI: 1346085602
Provider Name (Legal Business Name): STEVEN FISH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 THUNDER DR STE 208
VISTA CA
92083-6052
US

IV. Provider business mailing address

277 RODNEY AVE
ENCINITAS CA
92024-2901
US

V. Phone/Fax

Practice location:
  • Phone: 804-402-0540
  • Fax:
Mailing address:
  • Phone: 804-402-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN MICHAEL FISH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 804-402-0540