Provider Demographics
NPI:1619049509
Name:FEIL, FREDRICK (OD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:
Last Name:FEIL
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:PO BOX 1880
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:96020
Mailing Address - Country:US
Mailing Address - Phone:530-258-3101
Mailing Address - Fax:530-258-2020
Practice Address - Street 1:262 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CA
Practice Address - Zip Code:96020
Practice Address - Country:US
Practice Address - Phone:530-258-3101
Practice Address - Fax:530-258-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9579TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0095790Medicaid
CA4246630001Medicare NSC
CASD0095790Medicaid