Organization
GARY M FISHBERG O D PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY M FISHBERG O.D. (OPTOMETRIST/OWNER)
(951) 788-2020
Entity
Organization
Contact information
Practice address
5225 CANYON CREST DR, SUITE 201, RIVERSIDE, CA 92507-6301
(951) 788-2020
Mailing address
5225 CANYON CREST DR, SUITE 201, RIVERSIDE, CA 92507-6301
(951) 788-2020
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
6656T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0066562
—
CA
Enumeration date
06/06/2008
Last updated
03/11/2015
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