Provider Demographics
NPI:1578745733
Name:DR LINDA A FRECHETTE INC.
Entity Type:Organization
Organization Name:DR LINDA A FRECHETTE INC.
Other - Org Name:FAMILY EYE CARE SPECIALIST
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PURSIFULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-738-5348
Mailing Address - Street 1:951 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1239
Mailing Address - Country:US
Mailing Address - Phone:317-736-7715
Mailing Address - Fax:317-736-5976
Practice Address - Street 1:951 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1239
Practice Address - Country:US
Practice Address - Phone:317-736-7715
Practice Address - Fax:317-736-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ1921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200009800AMedicaid
IN439420Medicare PIN