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General NPI Number Information
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NPI Number | 1306059647
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Entity Type | Organization
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Legal Business Name | GREGORY J FISCHER KELLEY OPTICIANS
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 4128 EL CAMINO AVE SUITE 11
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City | SACRAMENTO
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State | CA
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Zip | 95821
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Country | US
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Telephone | 916-483-9293
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Fax | 916-973-0407
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Provider Business Mailing Address
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Address Line | 4128 EL CAMINO AVE SUITE 11
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City | SACRAMENTO
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State | CA
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Zip | 95821
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Country | US
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Telephone | 916-483-9293
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Fax | 916-973-0407
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY J FISCHER
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Credential | DISPENSING OPTICIAN
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Telephone | 916-483-9293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D6619
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License Number State | CA
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