Keith F Fishe, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1157T Issued in GA

Practice address

3580 Memorial Dr
Decatur, GA 30032-2723

Phone

(404) 284-0701

Fax

(404) 284-0703

NPI assigned

May 4, 2007

Last updated

Oct 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Eyecare Studio, LLC

  • Optometrist
  • Decatur, GA
  • NPI 1215463260
  Medicare reassignment NPD Authorized official
• Spectacle, LLC

  • Optometrist
  • Smyrna, GA
  • NPI 1821688268
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1649482274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2283 NORTH DECATUR RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300305423",
            "telephone_number": "770-314-3756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 MEMORIAL DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300322723",
            "telephone_number": "404-284-0701",
            "fax_number": "404-284-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHE",
        "first_name": "KEITH",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1157T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00528844A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00528844B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• First Care EMS Co
• First Choice Medical Supply, Inc
• First Family Home Care LLC
• First Medical Care Inc
• Firststop Medical Clinic LLC
• Jayanthi Chawan Fisher, D.M.D.
• Melanie C Fisher, APRN- CNS
• Vicki Genelle Fisher, LCSW
• Diane Marie Fisk, PA-C
• Fitly Spoken, LLC

• Optometrist in Decatur, GA
• Providers in Decatur, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.