Provider Demographics
NPI:1205884152
Name:FISCHER, KENNETH J (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:FISCHER
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 1:65-1227 OPELO RD
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8401
Mailing Address - Country:US
Mailing Address - Phone:808-885-4000
Mailing Address - Fax:
Practice Address - Street 1:65-1227 OPELO RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8401
Practice Address - Country:US
Practice Address - Phone:808-885-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIGP112ZMedicare PIN
T-11141Medicare UPIN
HI0794840001Medicare NSC