Provider Demographics
NPI:1275743718
Name:TAMI C. FRISKE, O.D., PC
Entity Type:Organization
Organization Name:TAMI C. FRISKE, O.D., PC
Other - Org Name:FRISKE OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRISKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-747-8583
Mailing Address - Street 1:5720 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3814
Mailing Address - Country:US
Mailing Address - Phone:520-747-8583
Mailing Address - Fax:520-747-8561
Practice Address - Street 1:5720 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3814
Practice Address - Country:US
Practice Address - Phone:520-747-8583
Practice Address - Fax:520-747-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS5055OtherDME
AZWCKGLMedicaid
AZS5055OtherDME
AZ0188710001Medicare NSC
AZZWCKGLMedicare PIN