MEDICARE: DR. SUSAN M. FRICK 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	152WC0802X	Corneal and Contact Management Optometrist	OPC3230	FL
2	152W00000X	Optometrist	OPC3230	FL

General Provider Information

NPI Number	:	1649406943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M. FRICK O.D.

Provider Business Mailing Address
First Line	:	2023 PROFESSIONAL CENTER DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073
Country	:	US
Telephone Number	:	904-272-2020
Fax Number	:	904-276-4386

Provider Business Practice Location Address
First Line	:	11406 SAN JOSE BLVD
Second Line	:	SUITE #1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-7963
Country	:	US
Telephone Number	:	904-260-3839
Fax Number	:	904-260-3604

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	11/17/2022

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