=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487690905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER FISHEL, OD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 03/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2797 CHARLES BLVD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-5933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-756-6031
-----------------------------------------------------
Fax | 252-756-9737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2797 CHARLES BLVD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27858-5933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-756-6031
-----------------------------------------------------
Fax | 252-756-9737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST / OWNER
-----------------------------------------------------
Name | JENNIFER R FISHEL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 252-756-6031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1791
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------