| Doctor Name: | DR. GREGORY J FAGERT |
| NPI Number: | 1366521726 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | 4099/T050 |
| Business Practice Address: | 14 N Main St Columbiana, OH - 444081347 |
| Business Phone Number: | 3304824124 |
| Business Fax Number: | |
| Mailing Address: | Po Box 355, COLUMBIANA |
| State: | OH |
| Postal Code: | 444080355 |
| Phone Number: | 3304824124 |
| Fax Number: | 3304824124 |
| NPI Enumeration Date: | 11/04/2006 |
| NPI Last Update Date: | 07/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 4099/T050 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |