Provider Demographics
NPI:1962498030
Name:FRICK, GARY M (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:FRICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10225 TELEPHONE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2804
Mailing Address - Country:US
Mailing Address - Phone:805-647-4950
Mailing Address - Fax:805-647-4969
Practice Address - Street 1:10225 TELEPHONE RD
Practice Address - Street 2:SUITE E
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2804
Practice Address - Country:US
Practice Address - Phone:805-647-4950
Practice Address - Fax:805-647-4969
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA7188T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0071880Medicaid
OP7188Medicare ID - Type Unspecified
CA0165290001Medicare NSC
T70180Medicare UPIN