Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 520 | AZ |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 520 | AZ |
N | 152WP0200X | Pediatric Optomitrist | 520 | AZ |
N | 152WV0400X | Optomitrist - Vision Therapist | 520 | AZ |
NPI | 1003812256 |
---|---|
Provider Name | Dr. Tami Cordt Friske |
First Address | Tucson, AZ 85750-6900 |
Second Address | Tucson, AZ 85711-3814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 27/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2477048 | AETNA (01) | AZ |
2Z4440 | HEALTHNET (01) | AZ |
AZ0175250 | BCBS (01) | AZ |
S5055 | DME (01) | AZ |
WCKGL | (05) | AZ |