Provider Demographics
NPI:1962988550
Name:FAHY, ELIZABETH CLARA (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CLARA
Last Name:FAHY
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:CMR 411 BOX 2164
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-0022
Mailing Address - Country:US
Mailing Address - Phone:502-548-5885
Mailing Address - Fax:
Practice Address - Street 1:US ARMY HEALTH CLINIC VILSECK - OPTOMETRY
Practice Address - Street 2:BUILDING 260
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:314-590-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006641152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH717470OtherMEDICARE
OH0349463Medicaid