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General NPI Number Information
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NPI Number | 1578624037
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Entity Type | Organization
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Legal Business Name | FRIDEL EYE ASSOCIATES, P.A.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 516 BANGS AVE
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City | ASBURY PARK
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State | NJ
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Zip | 07712-6902
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Country | US
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Telephone | 732-775-3805
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Fax | 732-775-3807
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Provider Business Mailing Address
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Address Line | 516 BANGS AVE
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City | ASBURY PARK
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State | NJ
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Zip | 07712-6902
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Country | US
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Telephone | 732-775-3805
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Fax | 732-775-3807
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Authorized Official
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Title or Position | OWNER OPTOMETRIC PHYSICIAN
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Name | DR. WILLIAM JOSEPH FRIDEL III
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Credential | OD
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Telephone | 732-775-3805
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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 | 27OA005921
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License Number State | NJ
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