MEDICARE: MICHAEL A. FISHBAUGH JR. O.D. INC.

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	4643 T1418	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410046531	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285814558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A. FISHBAUGH JR. O.D. INC.

Provider Business Mailing Address
First Line	:	570 E KREMER HOYING RD
Second Line	:
City	:	SAINT HENRY
State	:	OH
Zip	:	45883-9613
Country	:	US
Telephone Number	:	419-678-8800
Fax Number	:	419-678-4224

Provider Business Practice Location Address
First Line	:	570 E KREMER HOYING RD
Second Line	:
City	:	SAINT HENRY
State	:	OH
Zip	:	45883-9613
Country	:	US
Telephone Number	:	419-678-8800
Fax Number	:	419-678-4224

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. MICHAEL A FISHBAUGH JR.
Credential	:	O. D.
Telephone Number	:	419-678-8800

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	12/12/2023

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