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General NPI Number Information
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NPI Number | 1639338312
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Entity Type | Organization
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Legal Business Name | GARY M FISHBERG O D PROF CORP
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 5225 CANYON CREST DR SUITE 201
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City | RIVERSIDE
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State | CA
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Zip | 92507-6301
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Country | US
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Telephone | 951-788-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 CANYON CREST DR SUITE 201
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City | RIVERSIDE
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State | CA
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Zip | 92507-6301
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Country | US
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Telephone | 951-788-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. GARY M FISHBERG
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Credential | O.D.
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Telephone | 951-788-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 6656T
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License Number State | CA
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