MEDICARE: DR. JACLYNN ROSE FISHER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7210TG	TX

General Provider Information

NPI Number	:	1023262102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYNN ROSE FISHER O.D.

Provider Business Mailing Address
First Line	:	2020 W HIGHWAY 82
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-2051
Country	:	US
Telephone Number	:	940-612-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W HIGHWAY 82
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-2051
Country	:	US
Telephone Number	:	940-612-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2008
Last Update Date	:	11/16/2008

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