Individual
DR. MARK TERRENCE FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2640 BIEHN ST, KLAMATH FALLS, OR 97601-1181
(541) 884-3148
(541) 884-3373
Mailing address
2640 BIEHN ST, KLAMATH FALLS, OR 97601-1181
(541) 884-3148
(541) 884-3373
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
G58765
CA
207W00000X
Ophthalmology Physician
Primary
MD16253
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004571003
BCBS
OR
05
—
042937
—
OR
01
—
180011820
RAILROAD MEDICARE
OR
01
—
A002
TRICARE
OR
01
—
F2640501647611
VISION SERVICE PLAN
OR
01
—
XPY094350
MEDI-CAL
CA
Enumeration date
03/24/2006
Last updated
02/11/2021
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