Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 618 | AZ |
NPI | 1003814419 |
---|---|
Provider Name | Dr. Fred Nmn Fisch |
First Address | Scottsdale, AZ 85260-3879 |
Second Address | Mesa, AZ 85210-6008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 08/07/2007 |