1356416713 NPI number — DR SVETLANA FISHER AN OPTOMETRIC CORPORATION

Table of content: (NPI 1356416713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356416713 NPI number — DR SVETLANA FISHER AN OPTOMETRIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SVETLANA FISHER AN OPTOMETRIC CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356416713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7976 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90046-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-650-0988
Provider Business Mailing Address Fax Number:
323-650-1579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21001 SHERMAN WAY STE 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-3679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-230-4024
Provider Business Practice Location Address Fax Number:
818-276-0009
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
SVETLANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
323-650-0988

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  9936TPA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GSD003081 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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