Provider Demographics
NPI:1750726022
Name:FISHER-GENTRY EYE CARE PC
Entity type:Organization
Organization Name:FISHER-GENTRY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-545-0335
Mailing Address - Street 1:501 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1656
Mailing Address - Country:US
Mailing Address - Phone:815-468-2015
Mailing Address - Fax:815-468-2013
Practice Address - Street 1:501 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1656
Practice Address - Country:US
Practice Address - Phone:815-468-2015
Practice Address - Fax:815-468-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty