Provider Demographics
NPI:1407881667
Name:WILLIAM C. FRUCHTMAN OD PA
Entity Type:Organization
Organization Name:WILLIAM C. FRUCHTMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FRUCHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-728-9222
Mailing Address - Street 1:196 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1841
Mailing Address - Country:US
Mailing Address - Phone:201-728-9222
Mailing Address - Fax:201-728-9229
Practice Address - Street 1:196 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1841
Practice Address - Country:US
Practice Address - Phone:201-728-9222
Practice Address - Fax:201-728-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDN5374Medicare PIN
NJ102117Medicare PIN