Provider Demographics
NPI:1922447077
Name:FRIED, RACHEL RUTH (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:RUTH
Last Name:FRIED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3503
Mailing Address - Country:US
Mailing Address - Phone:917-805-4797
Mailing Address - Fax:347-640-3076
Practice Address - Street 1:1571 KIMBALL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3503
Practice Address - Country:US
Practice Address - Phone:917-805-4797
Practice Address - Fax:347-640-3076
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist