Healthcare Provider Details

I. General information

NPI: 1538162367
Provider Name (Legal Business Name): CARL M FISHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 E. 81ST STREET SUITE 100
TULSA OK
74133-5787
US

IV. Provider business mailing address

10010 E. 81ST STREET SUITE 100
TULSA OK
74133-5787
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-2020
  • Fax: 918-250-8910
Mailing address:
  • Phone: 919-250-2020
  • Fax: 918-250-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1676
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: