Basic Information
| Provider Information | |||||||||
| NPI: | 1487690905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JENNIFER FISHEL, OD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2797 CHARLES BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527566031 | ||||||||
| FaxNumber: | 2527569737 | ||||||||
| Practice Location | |||||||||
| Address1: | 2797 CHARLES BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527566031 | ||||||||
| FaxNumber: | 2527569737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 03/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | FISHEL | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2527566031 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1791 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0111Q | 01 | NC | BLUE CROSS GROUP NUMBER | OTHER |