Provider Demographics
NPI:1861423964
Name:FIDLER, DARLENE MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:MICHELLE
Last Name:FIDLER
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:PO BOX 15415
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-5415
Mailing Address - Country:US
Mailing Address - Phone:714-508-7400
Mailing Address - Fax:714-508-7408
Practice Address - Street 1:2791 GREEN RIVER RD STE 106
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7453
Practice Address - Country:US
Practice Address - Phone:951-736-2020
Practice Address - Fax:951-736-2002
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11352T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist