Provider Demographics
NPI:1932313533
Name:FRIEDRICH, ERIC J (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:FRIEDRICH
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 1:12685 PIONEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3756
Mailing Address - Country:US
Mailing Address - Phone:440-230-0821
Mailing Address - Fax:440-230-0821
Practice Address - Street 1:431 W BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1351
Practice Address - Country:US
Practice Address - Phone:440-891-8338
Practice Address - Fax:440-891-8959
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3856 T053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000166818OtherANTHEM GROUP ID
OH000000135027OtherANTHEM PHYSICIAN ID
OH0597901Medicare ID - Type Unspecified
OH000000166818OtherANTHEM GROUP ID