Provider Demographics
NPI:1679675276
Name:DR MAUREEN FAHEY AND ASSOCIATES
Entity Type:Organization
Organization Name:DR MAUREEN FAHEY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-735-2050
Mailing Address - Street 1:117 N ELY ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2941
Mailing Address - Country:US
Mailing Address - Phone:509-735-2050
Mailing Address - Fax:
Practice Address - Street 1:117 N ELY ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2941
Practice Address - Country:US
Practice Address - Phone:509-735-2050
Practice Address - Fax:509-735-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032142Medicaid
WAU43761Medicare UPIN
WA2032142Medicaid
WA6209730001Medicare NSC