Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 631 | ND |
NPI | 1013008655 |
---|---|
Provider Name | Dr. Douglas L Frohlich |
First Address | Jamestown, ND 58401-5553 |
Second Address | Jamestown, ND 58401-5553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26632 | BCBS OF ND (01) | ND |
60627 | (05) | ND |
U91498 | (02) | ND |