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General NPI Number Information
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NPI Number | 1871941138
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Entity Type | Organization
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Legal Business Name | MELISSA FREDERICK
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 1422 EUCLID AVE 802
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City | CLEVELAND
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State | OH
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Zip | 44115-1902
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Country | US
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Telephone | 314-750-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 LAFAYETTE DR
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City | WELDON SPRING
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State | MO
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Zip | 63304-7890
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Country | US
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Telephone | 314-750-1216
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Fax |
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Authorized Official
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Title or Position | OCULARIST/OWNER
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Name | MELISSA FREDERICK
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Credential | BCO
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Telephone | 314-750-1603
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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 | O.24
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License Number State | OH
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