Provider Demographics
NPI:1740416486
Name:FRISCH, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FRISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 LINCOLN ST
Mailing Address - Street 2:PREMIER OPTICAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1932
Mailing Address - Country:US
Mailing Address - Phone:508-852-3636
Mailing Address - Fax:
Practice Address - Street 1:591 LINCOLN ST
Practice Address - Street 2:PREMIER OPTICAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1932
Practice Address - Country:US
Practice Address - Phone:508-852-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist