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General NPI Number Information
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NPI Number | 1861423964
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Entity Type | Individual
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Provider Name | DARLENE MICHELLE FIDLER O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 2791 GREEN RIVER RD STE 106
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City | CORONA
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State | CA
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Zip | 92882-7453
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Country | US
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Telephone | 951-736-2020
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Fax | 951-736-2002
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Provider Business Mailing Address
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Address Line | PO BOX 15415
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City | IRVINE
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State | CA
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Zip | 92623-5415
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Country | US
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Telephone | 714-508-7400
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Fax | 714-508-7408
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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 | 11352T
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License Number State | CA
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