Provider Demographics
NPI:1295769271
Name:FAHRINGER, HEIDI MICHELE (OD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MICHELE
Last Name:FAHRINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3840 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-839-2090
Mailing Address - Fax:310-204-5858
Practice Address - Street 1:3840 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-839-2090
Practice Address - Fax:310-204-5858
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11632T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA204972OtherCIGNA
170719OtherEDS CCS GHP
1517OtherVISION PLAN OF AMERICA
3108392090OtherVSP
CA1632OtherEVE MED
13891OtherMES MEDICAL EYE SERVICES
CA204496VOtherCIGNA
CA7798400OtherAETNA
CA11632OtherVISION BENEFIT OF AMERICA
CA204972OtherCIGNA