Healthcare Provider Details

I. General information

NPI: 1356326649
Provider Name (Legal Business Name): RICHARD A FRIO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 FULTON AVE
CENTRAL SQUARE NY
13036
US

IV. Provider business mailing address

3248 FULTON AVE PO BOX 579
CENTRAL SQUARE NY
13036
US

V. Phone/Fax

Practice location:
  • Phone: 315-668-7999
  • Fax: 315-668-3530
Mailing address:
  • Phone: 315-668-7999
  • Fax: 315-668-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number003352-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003352-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: