Provider Demographics
NPI:1598750929
Name:FAHMY, AHMAD M (OD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:M
Last Name:FAHMY
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Gender:M
Credentials:OD
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Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUITE 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:952-567-6176
Practice Address - Street 1:710 E 24TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3840
Practice Address - Country:US
Practice Address - Phone:612-813-3600
Practice Address - Fax:612-813-3601
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-03-25
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Provider Licenses
StateLicense IDTaxonomies
MN2842152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00147507OtherRAILROAD MEDICARE
MN065860000Medicaid
MNU95137Medicare UPIN
MN065860000Medicaid