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General NPI Number Information
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NPI Number | 1033302294
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Entity Type | Organization
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Legal Business Name | MELVIN L. FRECKER O.D.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 304 S BALDWIN AVE
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City | MARION
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State | IN
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Zip | 46952-3528
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Country | US
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Telephone | 765-664-7647
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Fax | 765-668-1495
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Provider Business Mailing Address
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Address Line | PO BOX 479
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City | MARION
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State | IN
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Zip | 46952-0479
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Country | US
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Telephone | 765-664-7647
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Fax | 765-668-1495
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELVIN FRECKER
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Credential | O.D.
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Telephone | 765-664-7647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002023B
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License Number State | IN
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