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General NPI Number Information
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NPI Number | 1881862696
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Entity Type | Organization
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Legal Business Name | FREDERIC A. NEISTADT O.D.
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 2200 W HAMILTON ST SUITE 300
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City | ALLENTOWN
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State | PA
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Zip | 18104-6337
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Country | US
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Telephone | 610-437-0717
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Fax | 610-437-3741
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Provider Business Mailing Address
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Address Line | 2200 W HAMILTON ST SUITE 300
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City | ALLENTOWN
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State | PA
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Zip | 18104-6337
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Country | US
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Telephone | 610-437-0717
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Fax | 610-437-3741
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LAURIE VELAZQUEZ
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Credential | NRCMA
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Telephone | 610-437-0717
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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 | OEG000893
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License Number State | PA
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