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General NPI Number Information
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NPI Number | 1821052366
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Entity Type | Individual
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Provider Name | ALAN CHARLES FISHBERG O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1361 CHERRY AVE NE
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City | CANTON
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State | OH
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Zip | 44714-2528
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Country | US
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Telephone | 330-452-3646
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Fax |
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Provider Business Mailing Address
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Address Line | 4957 CARDINGTON GREEN CIR NW
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City | CANTON
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State | OH
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Zip | 44718-1564
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Country | US
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Telephone | 330-830-5460
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2705
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License Number State | OH
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