Healthcare Provider Details

I. General information

NPI: 1265953608
Provider Name (Legal Business Name): FISCHER LASER EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E BRIDGE ST STE B
REDWOOD FALLS MN
56283-1904
US

IV. Provider business mailing address

1801 19TH AVE SW
WILLMAR MN
56201-4946
US

V. Phone/Fax

Practice location:
  • Phone: 507-627-2020
  • Fax:
Mailing address:
  • Phone: 320-235-2020
  • Fax: 320-214-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2261
License Number StateMN

VIII. Authorized Official

Name: JEFFREY L FISCHER
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 320-235-2020