Provider Demographics
NPI:1487690905
Name:JENNIFER FISHEL, OD, PA
Entity type:Organization
Organization Name:JENNIFER FISHEL, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-756-6031
Mailing Address - Street 1:2797 CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5933
Mailing Address - Country:US
Mailing Address - Phone:252-756-6031
Mailing Address - Fax:252-756-9737
Practice Address - Street 1:2797 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5933
Practice Address - Country:US
Practice Address - Phone:252-756-6031
Practice Address - Fax:252-756-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0111QOtherBLUE CROSS GROUP NUMBER
NC2322449Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NC4354150001Medicare NSC