Provider Demographics
NPI:1124023619
Name:FREDERICKSON, JANICE BIANCHI (OD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:BIANCHI
Last Name:FREDERICKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 FREDRICKSON PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-9688
Mailing Address - Country:US
Mailing Address - Phone:724-837-1121
Mailing Address - Fax:724-837-1270
Practice Address - Street 1:2020 FREDRICKSON PL
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9688
Practice Address - Country:US
Practice Address - Phone:724-837-1121
Practice Address - Fax:724-837-1270
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU-26306Medicare UPIN
PA164855Medicare ID - Type Unspecified