Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901003760 | MI |
NPI | 1013091438 |
---|---|
Provider Name | Dr. Jana Marie Fisher |
First Address | Dewitt, MI 48820-7968 |
Second Address | Dewitt, MI 48820-9016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |