Provider Demographics
NPI:1407844616
Name:FRISCH, SANDFORD CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDFORD
Middle Name:CHARLES
Last Name:FRISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 OREGON PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4606
Mailing Address - Country:US
Mailing Address - Phone:717-569-0600
Mailing Address - Fax:717-569-4562
Practice Address - Street 1:2207 OREGON PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4606
Practice Address - Country:US
Practice Address - Phone:717-569-0600
Practice Address - Fax:717-569-4562
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042342E207W00000X
PA6000006421332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001150880003Medicaid
0729330001Medicare NSC
B11035Medicare UPIN
PA001150880003Medicaid