Individual
DR. JEROME ALLAN FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1560 UNIVERSITY AVE W, SAINT PAUL, MN 55104-3908
(651) 646-8889
(651) 646-3761
Mailing address
1600 VIEWCREST CIR, BURNSVILLE, MN 55306-5387
(952) 898-0513
(651) 646-3761
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2684
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140179
UCARE
MN
01
—
2201029
MEDICA
MN
01
—
32F04FA
BLUE CROSS/BLUE SHIELD
MN
01
—
40288
COLE MANAGED VISION
MN
01
—
MEDICAL ASSISTANCE
MINNESOTA
MN
Enumeration date
04/12/2006
Last updated
10/24/2011
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