Basic Information
Provider Information
NPI: 1285707034
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FISH
FirstName: ROBERT
MiddleName: ISAAC
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8381 SOUTHPARK LN
Address2:  
City: LITTLETON
State: CO
PostalCode: 801204508
CountryCode: US
TelephoneNumber: 3037300404
FaxNumber: 3037306163
Practice Location
Address1: 8381 SOUTHPARK LN
Address2:  
City: LITTLETON
State: CO
PostalCode: 801204508
CountryCode: US
TelephoneNumber: 3037300404
FaxNumber: 3037306163
Other Information
ProviderEnumerationDate: 11/16/2006
LastUpdateDate: 05/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XDR.0047880COY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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