Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | T004397-1 | NY |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | T004397-1 | NY |
Y | 152WS0006X | Sports Vision | T004397-1 | NY |
N | 152WV0400X | Optomitrist - Vision Therapist | T004397-1 | NY |
NPI | 1104991660 |
---|---|
Provider Name | Dr. Frederick Rolland Edmunds JR. |
First Address | Victor, NY 14564-8914 |
Second Address | Victor, NY 14564-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 20/02/2020 |