MEDICARE: DR. GARY M FRICK 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	7188T	CA

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	:	1962498030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY M FRICK OD

Provider Business Mailing Address
First Line	:	10225 TELEPHONE RD
Second Line	:	SUITE E
City	:	VENTURA
State	:	CA
Zip	:	93004-2804
Country	:	US
Telephone Number	:	805-647-4950
Fax Number	:	805-647-4969

Provider Business Practice Location Address
First Line	:	10225 TELEPHONE RD
Second Line	:	SUITE E
City	:	VENTURA
State	:	CA
Zip	:	93004-2804
Country	:	US
Telephone Number	:	805-647-4950
Fax Number	:	805-647-4969

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	04/10/2008

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