Provider Demographics
NPI:1740386655
Name:FRADY, LINDA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:FRADY
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 1425
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-1425
Mailing Address - Country:US
Mailing Address - Phone:828-697-6808
Mailing Address - Fax:828-697-7374
Practice Address - Street 1:60 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9405
Practice Address - Country:US
Practice Address - Phone:828-684-3800
Practice Address - Fax:828-684-7628
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890917UMedicaid
NCU90498Medicare UPIN
NC2472113AMedicare ID - Type Unspecified