Healthcare Provider Details

I. General information

NPI: 1477034312
Provider Name (Legal Business Name): FISCHER LASER EYE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 LEGION DR STE 2
MONTEVIDEO MN
56265-1729
US

IV. Provider business mailing address

1801 19TH AVE SW
WILLMAR MN
56201-4946
US

V. Phone/Fax

Practice location:
  • Phone: 320-321-1611
  • Fax: 320-321-1612
Mailing address:
  • Phone: 320-235-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: VALERIE J SELNESS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 320-235-2020