Provider Demographics
NPI:1912908872
Name:MUNZ, FREDERIC A (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:A
Last Name:MUNZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RIC
Other - Middle Name:
Other - Last Name:MUNZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:12205 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6200
Practice Address - Country:US
Practice Address - Phone:919-554-2020
Practice Address - Fax:919-556-4047
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000817152W00000X
NC955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909640Medicaid
NC09640OtherBCBS PROV #
NC540004216OtherRR MEDICARE INDIVIDUAL #
NC246267DMedicare PIN
NC09640OtherBCBS PROV #
NC8909640Medicaid