Ivy Elaine Frederick, OD, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG002192 Issued in PA

Legal business name

IVY ELAINE FREDERICK, OD, LLC

Practice address

2501 W State St
New Castle, PA 16101-1039

Phone

(724) 657-9686

NPI assigned

Jun 13, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ivy Frederick

Title

Optomitrist

Phone

(724) 924-1799

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246147200000",
    "number": "1053548396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2242 CENTER CHURCH RD",
            "city": "ELLWOOD CITY",
            "state": "PA",
            "postal_code": "161177804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W STATE ST",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161011039",
            "telephone_number": "724-657-9686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY ELAINE FREDERICK, OD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-13",
        "last_updated": "2009-06-28",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "IVY",
        "authorized_official_title_or_position": "OPTOMITRIST",
        "authorized_official_telephone_number": "724-924-1799"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in New Castle, PA
• Providers in New Castle, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.