Provider Demographics
NPI:1629451935
Name:FOGARTY, CORTNEY MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:MARIE
Last Name:FOGARTY
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 1:10101 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4025
Mailing Address - Country:US
Mailing Address - Phone:314-282-9050
Mailing Address - Fax:
Practice Address - Street 1:10101 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-4025
Practice Address - Country:US
Practice Address - Phone:314-282-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015021539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist