Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC003166 | FL |
NPI | 1003963307 |
---|---|
Provider Name | Holly Rebecca Fisher |
First Address | Longwood, FL 32750-3439 |
Second Address | Oviedo, FL 32765-9744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V06620 | (02) | FL |