Provider Demographics
NPI:1982694915
Name:FRUZYNSKI, STANLEY A (OD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:FRUZYNSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 TRI COUNTY LN
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1987
Mailing Address - Country:US
Mailing Address - Phone:724-929-2229
Mailing Address - Fax:
Practice Address - Street 1:710 TRI COUNTY LN
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1987
Practice Address - Country:US
Practice Address - Phone:724-929-2229
Practice Address - Fax:724-929-2907
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087674ZEHDMedicare PIN
0428690001Medicare NSC