Provider Demographics
NPI:1457440687
Name:FRISCHKNECHT, NEIL (OD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:FRISCHKNECHT
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 1:1901 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2001
Mailing Address - Country:US
Mailing Address - Phone:801-886-2020
Mailing Address - Fax:801-954-0054
Practice Address - Street 1:3754 W 5400 S
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-3574
Practice Address - Country:US
Practice Address - Phone:801-964-9911
Practice Address - Fax:801-964-1810
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1092671601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000009922OtherMEDICARE STORE #16 PTAN
UT000009841OtherMEDICARE STORE #13 PTAN
UT999000797009Medicaid
UT$$$$$$$$$14001OtherBC/BS #7
UT000009841OtherMEDICARE STORE #13 PTAN
UT0618950011Medicare NSC
UT009926003Medicare PIN
UT009922003Medicare PIN
UT999000797009Medicaid
UT000009841OtherMEDICARE STORE #13 PTAN
UT000009922OtherMEDICARE STORE #16 PTAN
UTU32401Medicare UPIN