Provider Demographics
NPI:1619011822
Name:RAPPS, FREDRIC BARRY (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:FREDRIC
Middle Name:BARRY
Last Name:RAPPS
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3705
Mailing Address - Country:US
Mailing Address - Phone:516-481-1132
Mailing Address - Fax:
Practice Address - Street 1:2453 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4710
Practice Address - Country:US
Practice Address - Phone:516-746-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3934156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician