MEDICARE: DR. TAMI CORDT FRISKE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	520	AZ
2	152WC0802X	Corneal and Contact Management Optometrist	520	AZ
3	152WP0200X	Pediatric Optometrist	520	AZ
4	152WV0400X	Vision Therapy Optometrist	520	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2477048	OTHER	AZ	AETNA
3	2Z4440	OTHER	AZ	HEALTHNET
4	AZ0175250	OTHER	AZ	BCBS
5	S5055	OTHER	AZ	DME

General Provider Information

NPI Number	:	1003812256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMI CORDT FRISKE OD

Provider Business Mailing Address
First Line	:	4464 N LITTLE ROCK DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6900
Country	:	US
Telephone Number	:	520-749-4973
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3814
Country	:	US
Telephone Number	:	520-747-8583
Fax Number	:	520-747-8561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/27/2008

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