Provider Demographics
NPI:1356326649
Name:FRIO, RICHARD A (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FRIO
Suffix:
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 1:3248 FULTON AVE
Mailing Address - Street 2:PO BOX 579
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036
Mailing Address - Country:US
Mailing Address - Phone:315-668-7999
Mailing Address - Fax:315-668-3530
Practice Address - Street 1:3248 FULTON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036
Practice Address - Country:US
Practice Address - Phone:315-668-7999
Practice Address - Fax:315-668-3530
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003352-1152W00000X
NYTUV003352-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00562487Medicaid
NY00562487Medicaid
NY37361BMedicare ID - Type UnspecifiedUPSTATE MEDICARE
NY0279480001Medicare NSC