Provider Demographics
NPI:1518040997
Name:MOBILE OPTOMETRY, LLC
Entity Type:Organization
Organization Name:MOBILE OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-453-3785
Mailing Address - Street 1:975 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3049
Mailing Address - Country:US
Mailing Address - Phone:740-453-3785
Mailing Address - Fax:740-422-0311
Practice Address - Street 1:716 MARKET ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3716
Practice Address - Country:US
Practice Address - Phone:740-453-3785
Practice Address - Fax:740-422-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018646410001Medicaid
OH2447276Medicaid
OH2447276Medicaid
OH9336151Medicare ID - Type Unspecified