Provider Demographics
NPI:1245592625
Name:FAY, JONATHAN DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DEAN
Last Name:FAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 BIEHN ST.
Mailing Address - Street 2:STE 3
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1181
Mailing Address - Country:US
Mailing Address - Phone:541-884-3148
Mailing Address - Fax:541-884-3373
Practice Address - Street 1:2640 BIEHN ST STE 3
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1181
Practice Address - Country:US
Practice Address - Phone:541-884-3148
Practice Address - Fax:541-884-3373
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283073207W00000X
ORMD181538207WX0120X, 207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500725690Medicaid
NYMEDICAIDMedicaid
NYMEDICAIDMedicaid