MEDICARE: CARL M FISHER DO

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	207W00000X	Ophthalmology Physician	1676	OK

General Provider Information

NPI Number	:	1538162367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL M FISHER DO

Provider Business Mailing Address
First Line	:	10010 E. 81ST STREET
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74133-5787
Country	:	US
Telephone Number	:	919-250-2020
Fax Number	:	918-250-8910

Provider Business Practice Location Address
First Line	:	10010 E. 81ST STREET
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74133-5787
Country	:	US
Telephone Number	:	919-250-2020
Fax Number	:	918-250-8910

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/10/2010

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