Healthcare Provider Details

I. General information

NPI: 1760877120
Provider Name (Legal Business Name): STEVEN FISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
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: 804-402-0540
Mailing address:
  • Phone: 804-402-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101285625
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA164497
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA164497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: