MEDICARE: WILLIAM C. FRUCHTMAN OD PA

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	27OA00514400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922282763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM C. FRUCHTMAN OD PA

Provider Business Mailing Address
First Line	:	196 PATERSON AVE
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-1841
Country	:	US
Telephone Number	:	201-728-9222
Fax Number	:	201-728-9229

Provider Business Practice Location Address
First Line	:	196 PATERSON AVE
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-1841
Country	:	US
Telephone Number	:	201-728-9222
Fax Number	:	201-728-9229

Authorized Official
Title or Position	:	OPTOMETRIC PHYSICIAN
Name	:	DR. WILLIAM CHARLES FRUCHTMAN
Credential	:	OD
Telephone Number	:	201-728-9222

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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