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General NPI Number Information
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NPI Number | 1568411593
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Entity Type | Individual
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Provider Name | SUSAN KERSEY FISH MD
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 333 N. RIVERSHIRE DR. SUITE 160
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City | CONROE
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State | TX
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Zip | 77304-2711
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Country | US
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Telephone | 936-441-2020
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Fax | 936-756-0656
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Provider Business Mailing Address
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Address Line | 2855 GRAMERCY ST STE 400
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City | HOUSTON
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State | TX
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Zip | 77025-1697
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Country | US
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Telephone | 713-668-6828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M1092
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License Number State | TX
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