Healthcare Provider Details

I. General information

NPI: 1669968509
Provider Name (Legal Business Name): LIZABETH FRONTINO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 UNIVERSITY BLVD E STE 1
HYATTSVILLE MD
20783-4137
US

IV. Provider business mailing address

2045 UNIVERSITY BLVD E STE 100
HYATTSVILLE MD
20783-4153
US

V. Phone/Fax

Practice location:
  • Phone: 240-847-7371
  • Fax: 240-847-7391
Mailing address:
  • Phone: 301-431-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA3138
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2072-T
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003412
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: