Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DPO00218 | TN |
NPI | 1124143755 |
---|---|
Provider Name | Mr. Fredie Cecil Frost |
First Address | Chattanooga, TN 37411-4008 |
Second Address | Chattanooga, TN 37411-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 16/01/2008 |