Provider Demographics
NPI:1508564436
Name:FEJEDELEM, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FEJEDELEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SINGLETARY DR
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-3975
Mailing Address - Country:US
Mailing Address - Phone:330-422-2168
Mailing Address - Fax:330-422-2170
Practice Address - Street 1:905 SINGLETARY DR
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-3975
Practice Address - Country:US
Practice Address - Phone:330-422-2168
Practice Address - Fax:330-422-2170
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5179156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician