Active NPI
Alan P Fisher, O.D.
- Optometrist
- Lakeland, FL
National Provider Identifier
1982792412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC1217
- Practice address
- 2025 E Edgewood Dr
Lakeland, FL 33803-3601 - Phone
- (863) 665-4515
- Fax
- (863) 665-4516
- NPI assigned
- Oct 10, 2006
- Last updated
- May 26, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC1217 | FL | Primary |
Addresses
Primary practice location
2025 E Edgewood Dr
Lakeland, FL 33803-3601
Mailing address
2025 E Edgewood Dr
Lakeland, FL 33803-3601
Phone (863) 665-4515
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 540002113 | Other | RAILROAD MEDICARE | |
| 591268685 | Other | FL | TAX ID |
| OP1217 899 | Other | FL | WORKERS COMP |
| 084841700 | Medicaid | FL | |
| 19436 | Other | FL | BCBS |
| 4269694 | Other | AETNA | |
| U10328 | Other | DMERC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC1217 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306368000000",
"number": "1982792412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2025 E EDGEWOOD DR",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338033601",
"telephone_number": "863-665-4515",
"fax_number": "863-665-4516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 E EDGEWOOD DR",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338033601",
"telephone_number": "863-665-4515",
"fax_number": "863-665-4516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHER",
"first_name": "ALAN",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2011-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC1217",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "540002113",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "591268685",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMP",
"identifier": "OP1217 899",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "084841700",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "19436",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4269694",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "U10328",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.