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General NPI Number Information
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NPI Number | 1669532040
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Entity Type | Organization
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Legal Business Name | FISHER FOODS MARKETING INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 8100 CLEVELAND AVE NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-5664
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Country | US
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Telephone | 330-433-1180
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Fax | 330-305-0600
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Provider Business Mailing Address
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Address Line | 4855 FRANK ROAD NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-7425
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Country | US
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Telephone | 330-497-0205
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Fax | 330-497-1142
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Authorized Official
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Title or Position | OPTICAL SUPERVISOR
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Name | MR. DONALD ARTHUR DUERR
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Credential | LDO
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Telephone | 330-497-0205
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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 | 801S
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License Number State | OH
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