Basic Information
| Provider Information | |||||||||
| NPI: | 1003015363 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISH | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 731 N COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087343937 | ||||||||
| FaxNumber: | 2087347585 | ||||||||
| Practice Location | |||||||||
| Address1: | 731 N COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087343937 | ||||||||
| FaxNumber: | 2087347585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 04/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | ODP100141 | ID | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.