Healthcare Provider Details

I. General information

NPI: 1962453241
Provider Name (Legal Business Name): FREDERICK WEB FRAUNFELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 EXECUTIVE PARKWAY DR STE 200
SAINT LOUIS MO
63141-6340
US

IV. Provider business mailing address

PO BOX 736480
CHICAGO IL
60673-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-394-3201
  • Fax: 314-394-3253
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2014008010
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number2014008010
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: