Provider Demographics
NPI:1609915578
Name:FROST, FREDERICK ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALLEN
Last Name:FROST
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 1:716 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3716
Mailing Address - Country:US
Mailing Address - Phone:740-453-3785
Mailing Address - Fax:740-453-1883
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:740-453-1883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4105152W00000X
PAOEG001200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0748507Medicaid
PA0018646410001Medicaid
PA0018646410001Medicaid
PA050856Medicare ID - Type Unspecified
OH0642481Medicare ID - Type UnspecifiedINDIVIDUAL