Individual
DR. GREGORY J FAGERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
14 N MAIN ST, COLUMBIANA, OH 44408-1347
(330) 482-4124
Mailing address
PO BOX 355, COLUMBIANA, OH 44408-0355
(330) 482-4124
(330) 482-4124
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4099/T050
OH
152WC0802X
Corneal and Contact Management Optometrist
4099/T050
OH
152WL0500X
Low Vision Rehabilitation Optometrist
4099/T050
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
976574
—
OH
Enumeration date
11/04/2006
Last updated
07/22/2011
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