Healthcare Provider Details

I. General information

NPI: 1508933011
Provider Name (Legal Business Name): FISCHER LASER EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MAIN ST S
NEW LONDON MN
56273-5005
US

IV. Provider business mailing address

61 MAIN ST S
NEW LONDON MN
56273-5005
US

V. Phone/Fax

Practice location:
  • Phone: 320-354-2020
  • Fax:
Mailing address:
  • Phone: 320-354-2020
  • Fax: 320-354-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEFFREY L. FISCHER
Title or Position: OWNER PROVIDER
Credential: M.D.
Phone: 320-235-2020