Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OET008970 | PA |
NPI | 1003909805 |
---|---|
Provider Name | Dr. Heather M Fagnani |
First Address | Exton, PA 19341-2654 |
Second Address | Exton, PA 19341-2654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 09/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01440 | (02) |