Provider Demographics
NPI:1598893067
Name:FAES, FREDERICK F (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:F
Last Name:FAES
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 1:5865 WHITMORE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1945
Mailing Address - Country:US
Mailing Address - Phone:810-227-5640
Mailing Address - Fax:
Practice Address - Street 1:5865 WHITMORE LAKE RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1945
Practice Address - Country:US
Practice Address - Phone:810-227-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFF002662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D76504OtherBLUE CROSS
MIVCM0013OtherUOF M HMO