Provider Demographics
NPI:1598703878
Name:FORGNONI, FRANK W (OD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:W
Last Name:FORGNONI
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 1:7611 HWY 76
Mailing Address - Street 2:STE B
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9162
Mailing Address - Country:US
Mailing Address - Phone:864-646-3535
Mailing Address - Fax:
Practice Address - Street 1:7611 HIGHWAY 76
Practice Address - Street 2:STE B
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-9162
Practice Address - Country:US
Practice Address - Phone:864-646-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1393152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13938Medicaid
SC5826Medicare PIN
SCU707495826Medicare UPIN
SCD13938Medicaid