Provider Demographics
NPI:1326212929
Name:FAGEDES AND GARRITY, LLC
Entity Type:Organization
Organization Name:FAGEDES AND GARRITY, LLC
Other - Org Name:JENNIFER FAGEDES AND JOHN GARRITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:513-621-0979
Mailing Address - Street 1:632 VINE ST.
Mailing Address - Street 2:STE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2436
Mailing Address - Country:US
Mailing Address - Phone:513-621-0979
Mailing Address - Fax:513-421-5345
Practice Address - Street 1:632 VINE ST
Practice Address - Street 2:STE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2425
Practice Address - Country:US
Practice Address - Phone:513-621-0979
Practice Address - Fax:513-421-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4194-T055152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0473280001Medicare NSC