Provider Demographics
NPI:1689668162
Name:FAGEDES, JENNIFER MARY (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:FAGEDES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 7TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2476
Mailing Address - Country:US
Mailing Address - Phone:513-621-0979
Mailing Address - Fax:513-421-5345
Practice Address - Street 1:35 E 7TH ST
Practice Address - Street 2:STE 400
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2476
Practice Address - Country:US
Practice Address - Phone:513-621-0979
Practice Address - Fax:513-421-5345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4098-T1093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0957666Medicaid
OHFA0732371Medicare ID - Type Unspecified
OHU48759Medicare UPIN