Provider Demographics
NPI:1174683106
Name:FRUTCHEY, MARCUS PETER III (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:PETER
Last Name:FRUTCHEY
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 TOWNE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7404
Mailing Address - Country:US
Mailing Address - Phone:407-302-4480
Mailing Address - Fax:407-268-3241
Practice Address - Street 1:157 TOWNE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7404
Practice Address - Country:US
Practice Address - Phone:407-302-4480
Practice Address - Fax:407-268-3241
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20592ZMedicare ID - Type Unspecified
FLU57149Medicare UPIN