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General NPI Number Information
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NPI Number | 1982636783
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Entity Type | Individual
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Provider Name | LAURA FREDERICK O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 9600 MAIN ST SUITE H
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City | FAIRFAX
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State | VA
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Zip | 22031-3798
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Country | US
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Telephone | 703-764-3937
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Fax | 703-764-3986
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Provider Business Mailing Address
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Address Line | 9600 MAIN ST SUITE H
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City | FAIRFAX
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State | VA
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Zip | 22031-3798
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Country | US
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Telephone | 703-764-3937
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Fax | 703-764-3986
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0618001477
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3889
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1945
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License Number State | MD
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