Provider Demographics
NPI:1184812570
Name:UPTOWN EYECARE & OPTICAL, P.C.
Entity type:Organization
Organization Name:UPTOWN EYECARE & OPTICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZUZANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:503-228-3838
Mailing Address - Street 1:2370 W. BURNSIDE ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3537
Mailing Address - Country:US
Mailing Address - Phone:503-228-3838
Mailing Address - Fax:503-226-8031
Practice Address - Street 1:2370 W. BURNSIDE ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3537
Practice Address - Country:US
Practice Address - Phone:503-228-3838
Practice Address - Fax:503-226-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1630ATI152W00000X
OR3244AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR117662Medicare PIN
ORT67561Medicare UPIN
R117662Medicare Oscar/Certification