Basic Information
| Provider Information | |||||||||
| NPI: | 1902258015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HOFFMAN | ||||||||
| OtherFirstName: | MEGAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15933 CLAYTON RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362004393 | ||||||||
| FaxNumber: | 6365270838 | ||||||||
| Practice Location | |||||||||
| Address1: | 1064 STATE ROUTE 26 SUITE B | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138313166 | ||||||||
| FaxNumber: | 5138312933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2016 | ||||||||
| LastUpdateDate: | 11/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 6464 T3381 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.