MEDICARE: FRIEDRICHS FAMILY EYE CENTER PC

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

General Provider Information

NPI Number	:	1285278754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIEDRICHS FAMILY EYE CENTER PC

Provider Business Mailing Address
First Line	:	1975 VIRGINIA AVE
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-8388
Country	:	US
Telephone Number	:	276-647-3937
Fax Number	:	276-647-3990

Provider Business Practice Location Address
First Line	:	395 S MAIN ST
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1710
Country	:	US
Telephone Number	:	540-483-0284
Fax Number	:	540-483-9680

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRAY W. FRIEDRICHS
Credential	:	OD
Telephone Number	:	276-647-3937

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	10/29/2019

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