Provider Demographics
NPI:1568203354
Name:FUSON, ISAIAH JACINTO (OD)
Entity type:Individual
Prefix:DR
First Name:ISAIAH
Middle Name:JACINTO
Last Name:FUSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2816
Mailing Address - Country:US
Mailing Address - Phone:559-222-0220
Mailing Address - Fax:
Practice Address - Street 1:20 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2816
Practice Address - Country:US
Practice Address - Phone:559-222-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist