Provider Demographics
NPI:1649406943
Name:FRICK, SUSAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:FRICK
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2023 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-272-2020
Mailing Address - Fax:904-276-4386
Practice Address - Street 1:11406 SAN JOSE BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7963
Practice Address - Country:US
Practice Address - Phone:904-260-3839
Practice Address - Fax:904-260-3604
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC3230152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTAN-CO189AMedicare UPIN