Provider Demographics
NPI:1164696027
Name:DR PHILLIP R FRUGE PC
Entity Type:Organization
Organization Name:DR PHILLIP R FRUGE PC
Other - Org Name:VALLEY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRUGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-423-4333
Mailing Address - Street 1:506 E VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6836
Mailing Address - Country:US
Mailing Address - Phone:956-423-4333
Mailing Address - Fax:956-425-2020
Practice Address - Street 1:506 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6836
Practice Address - Country:US
Practice Address - Phone:956-423-4333
Practice Address - Fax:956-425-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01895TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0256960001Medicare NSC