Provider Demographics
NPI:1669968509
Name:FRONTINO, LIZABETH (OD)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:
Last Name:FRONTINO
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:PO BOX 208869
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8869
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:6756 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-6701
Practice Address - Country:US
Practice Address - Phone:703-768-1677
Practice Address - Fax:703-765-6483
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2072-T152W00000X
VA0618003109152W00000X
PAOEG003412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist