Provider Demographics
NPI:1972781565
Name:FRIDEN OPTOMETRY INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FRIDEN OPTOMETRY INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FRIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-283-2020
Mailing Address - Street 1:68 CENTRAL AVE
Mailing Address - Street 2:STE C
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9718
Mailing Address - Country:US
Mailing Address - Phone:530-283-2020
Mailing Address - Fax:
Practice Address - Street 1:68 CENTRAL AVE
Practice Address - Street 2:STE C
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9718
Practice Address - Country:US
Practice Address - Phone:530-283-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2643038Medicaid
CA6154020001Medicare NSC
CAZZZ0752ZMedicare PIN