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General NPI Number Information
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NPI Number | 1316358245
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Entity Type | Individual
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Provider Name | PATRICK K FAHEY O.D,
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Gender | Male
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 3950 GRANDVIEW DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-3163
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Country | US
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Telephone | 864-963-6168
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1025
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City | HENDERSONVILLE
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State | NC
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Zip | 28793-1025
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Country | US
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Telephone | 828-329-1649
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1383
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 958-224T
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3170T
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License Number State | TX
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