Provider Demographics
NPI:1447346416
Name:FANT, EMILY L (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:L
Last Name:FANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3085 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2999
Mailing Address - Country:US
Mailing Address - Phone:805-416-8509
Mailing Address - Fax:949-618-6205
Practice Address - Street 1:3085 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2916
Practice Address - Country:US
Practice Address - Phone:805-416-8509
Practice Address - Fax:949-688-6205
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV5652207W00000X
CAG198508207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447346416Medicaid
NV562OtherNEVADACARE
NV002019015Medicaid
NVB99147Medicare UPIN
NV002019015Medicaid
NVANTHEM BCBSOtherNV0066