MEDICARE: TIMOTHY LA FRENIERE 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	0618002136	VA

General Provider Information

NPI Number	:	1902151244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY LA FRENIERE OD

Provider Business Mailing Address
First Line	:	9314 OLD KEENE MILL RD STE A
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-4284
Country	:	US
Telephone Number	:	703-569-3131
Fax Number	:	703-451-9291

Provider Business Practice Location Address
First Line	:	9314 OLD KEENE MILL RD STE A
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-4284
Country	:	US
Telephone Number	:	703-569-3131
Fax Number	:	703-451-9291

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/23/2012

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