Healthcare Provider Details

I. General information

NPI: 1235705849
Provider Name (Legal Business Name): CYDNEY CAYE FROEHLICH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 N TATUM BLVD STE 20
PHOENIX AZ
85050-4207
US

IV. Provider business mailing address

4750 E UNION HILLS DR APT 3037
PHOENIX AZ
85050-3371
US

V. Phone/Fax

Practice location:
  • Phone: 480-419-9750
  • Fax:
Mailing address:
  • Phone: 952-356-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3726
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002518
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: