Individual
DR. ANGELA FAHEY COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
138 E REYNOLDS RD, SUITE #101, LEXINGTON, KY 40517-1257
(859) 273-2020
(859) 272-8089
Mailing address
138 E REYNOLDS RD, SUITE #101, LEXINGTON, KY 40517-1257
(859) 273-2020
(859) 272-8089
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1661DT
KY
152WP0200X
Pediatric Optometrist
1661DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1661DT
STATE LICENSURE
KY
01
—
OPT002576
GEORGIA LICENSE
GA
Enumeration date
08/09/2006
Last updated
08/21/2018
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