Healthcare Provider Details

I. General information

NPI: 1356726566
Provider Name (Legal Business Name): JOHN FISCHER, OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MAIN ST
DURYEA PA
18642-1030
US

IV. Provider business mailing address

247 MAIN ST
DURYEA PA
18642-1030
US

V. Phone/Fax

Practice location:
  • Phone: 570-457-5414
  • Fax: 570-451-6332
Mailing address:
  • Phone: 570-457-5414
  • Fax: 570-451-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA E FISCHER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 570-313-1657