MEDICARE: FREDERICK PETER DARIN 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	4901002253	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410029435	OTHER		MEDICARE RAILROAD
3	410029435	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	FD002253	OTHER	MI	BCBS
4	22-00020	OTHER	MI	PHP

General Provider Information

NPI Number	:	1306952544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK PETER DARIN OD

Provider Business Mailing Address
First Line	:	123 LANSING ST
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1696
Country	:	US
Telephone Number	:	517-543-2020
Fax Number	:	517-543-0311

Provider Business Practice Location Address
First Line	:	123 LANSING ST
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1696
Country	:	US
Telephone Number	:	517-543-2020
Fax Number	:	517-543-0311

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	06/22/2010

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