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General NPI Number Information
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NPI Number | 1841926599
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Entity Type | Organization
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Legal Business Name | FREDERICK CUSTOMEYEZ PROSTHETICS LLC
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1834 CRAIG RD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4712
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Country | US
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Telephone | 401-584-3939
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Fax | 216-678-9186
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Provider Business Mailing Address
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Address Line | PO BOX 27802
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City | SAINT LOUIS
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State | MO
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Zip | 63146-1302
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Country | US
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Telephone | 401-584-3939
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Fax | 216-678-9186
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA FREDERICK
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Credential |
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Telephone | 401-584-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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