Provider Demographics
NPI:1619107406
Name:FAZZARY, ASHLEY BROOKE (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BROOKE
Last Name:FAZZARY
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 1:1321 FREER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8121
Mailing Address - Country:US
Mailing Address - Phone:607-228-7179
Mailing Address - Fax:
Practice Address - Street 1:415 KING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-6407
Practice Address - Country:US
Practice Address - Phone:888-492-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist