Provider Demographics
NPI:1407047566
Name:FAHMY, MONA M (OD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:M
Last Name:FAHMY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-567-6092
Mailing Address - Fax:952-884-2656
Practice Address - Street 1:9801 DUPONT AVE S STE 200
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3200
Practice Address - Country:US
Practice Address - Phone:528-885-8009
Practice Address - Fax:952-567-6156
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3084152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN776473000Medicaid
MN410002658Medicare PIN