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NPI Code Detail

MEDICARE: DR. AUSTIN EMORY FAY OD

MEDICARE: DR. AUSTIN EMORY FAY OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist6252FL

General Provider Information

NPI Number : 1982389433
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUSTIN EMORY FAY OD
Provider Business Mailing Address
First Line : 6204 MACKENZIE PL
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-6748
Country : US
Telephone Number : 217-206-5453
Fax Number :
Provider Business Practice Location Address
First Line : 161 HAMPTON POINT DR STE 3
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32092-3058
Country : US
Telephone Number : 904-204-3345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2023
Last Update Date : 06/21/2023

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Directions to “ DR. AUSTIN EMORY FAY OD” Practice Location

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