Provider Demographics
NPI:1902238314
Name:FISHER, BRIAN DAVID (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:FISHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 SE 165TH MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5884
Mailing Address - Country:US
Mailing Address - Phone:352-674-5130
Mailing Address - Fax:352-674-5027
Practice Address - Street 1:8900 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5884
Practice Address - Country:US
Practice Address - Phone:352-674-5130
Practice Address - Fax:352-674-5027
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 002781152W00000X
FLOPC 4987152W00000X
NJ27OA00655300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist