Provider Demographics
NPI:1295956993
Name:FISCHER, GREGORY JAMES (REG DISPENSING OPTIC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAMES
Last Name:FISCHER
Suffix:
Gender:M
Credentials:REG DISPENSING OPTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 EL CAMINO AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821
Mailing Address - Country:US
Mailing Address - Phone:916-483-9293
Mailing Address - Fax:916-973-0407
Practice Address - Street 1:4128 EL CAMINO AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-483-9293
Practice Address - Fax:916-973-0407
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6619156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265880001Medicare ID - Type Unspecified