Healthcare Provider Details

I. General information

NPI: 1407047566
Provider Name (Legal Business Name): MONA M FAHMY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUPONT AVE S STE 200
BLOOMINGTON MN
55431-3200
US

IV. Provider business mailing address

9801 DUPONT AVE S 425
BLOOMINGTON MN
55431-3100
US

V. Phone/Fax

Practice location:
  • Phone: 528-885-8009
  • Fax: 952-567-6156
Mailing address:
  • Phone: 952-567-6092
  • Fax: 952-884-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3084
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: