Provider Demographics
NPI:1538223532
Name:FISHER, AMY A (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 S. BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5412
Mailing Address - Country:US
Mailing Address - Phone:903-525-9502
Mailing Address - Fax:903-525-9465
Practice Address - Street 1:2756 S BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5412
Practice Address - Country:US
Practice Address - Phone:903-525-9502
Practice Address - Fax:903-525-9465
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6010T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00072391OtherMEDICARE RR
TX143578601Medicaid
TX80339QOtherBCBS
TX143578601Medicaid
TXP00072391OtherMEDICARE RR