Provider Demographics
NPI:1487734133
Name:FISCHER, LINDA L (OD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:FISCHER
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 1:1125 MEDICAL PL
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2639
Mailing Address - Country:US
Mailing Address - Phone:812-522-1800
Mailing Address - Fax:812-522-6932
Practice Address - Street 1:1125 MEDICAL PL
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2639
Practice Address - Country:US
Practice Address - Phone:812-522-1800
Practice Address - Fax:812-522-6932
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002246B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100140670AMedicaid
IN100140670AMedicaid
INT34769Medicare UPIN