Provider Demographics
NPI:1194421156
Name:DIANA L FISHER OD LLC
Entity type:Organization
Organization Name:DIANA L FISHER OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-207-2868
Mailing Address - Street 1:2776 E 146TH ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7718
Mailing Address - Country:US
Mailing Address - Phone:317-207-2868
Mailing Address - Fax:317-669-2016
Practice Address - Street 1:2776 E 146TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7718
Practice Address - Country:US
Practice Address - Phone:317-207-2868
Practice Address - Fax:317-669-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty