Provider Demographics
NPI:1508042052
Name:PETER FRISKO, O.D.
Entity Type:Organization
Organization Name:PETER FRISKO, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:P
Authorized Official - Last Name:FRISKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-653-0202
Mailing Address - Street 1:222 NEW RD
Mailing Address - Street 2:CENTRAL PARK EAST, SUITE 105
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1299
Mailing Address - Country:US
Mailing Address - Phone:609-653-0202
Mailing Address - Fax:609-653-2929
Practice Address - Street 1:222 NEW RD
Practice Address - Street 2:CENTRAL PARK EAST, SUITE 105
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1299
Practice Address - Country:US
Practice Address - Phone:609-653-0202
Practice Address - Fax:609-653-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ2693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4413220001Medicare NSC
NJU24914Medicare UPIN
NJ130956Medicare PIN