MEDICARE: DR. FREDERICK WILLIAM SCARPACE O.D.

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	4901002264	MI

General Provider Information

NPI Number	:	1215927769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK WILLIAM SCARPACE O.D.

Provider Business Mailing Address
First Line	:	25350 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2102
Country	:	US
Telephone Number	:	313-563-2020
Fax Number	:	313-274-1605

Provider Business Practice Location Address
First Line	:	25350 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2102
Country	:	US
Telephone Number	:	313-563-2020
Fax Number	:	313-274-1605

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/21/2012

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