Provider Demographics
NPI:1851024814
Name:FROELICHER, MARY KATHLEEN (ABO, NCLE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:FROELICHER
Suffix:
Gender:F
Credentials:ABO, NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 DOERING DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4211
Mailing Address - Country:US
Mailing Address - Phone:859-525-6681
Mailing Address - Fax:859-525-6709
Practice Address - Street 1:7625 DOERING DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4211
Practice Address - Country:US
Practice Address - Phone:859-525-6681
Practice Address - Fax:859-525-6709
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110904156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician