Individual provider Active NPI

Frederick Rolland Edmunds Jr., O.D.

  • Sports Vision Optometrist
  • Victor, NY
National Provider Identifier
1104991660
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Vision OptometristTaxonomy code 152WS0006X
License
T004397-1 Issued in NY
Practice address
274 W Main St
Victor, NY 14564-1157
Phone
(585) 880-4818
NPI assigned
Nov 21, 2006
Last updated
Jul 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4397 NY
Optometrist 152W00000X T004397-1 NY
Corneal and Contact Management Optometrist 152WC0802X T004397-1 NY
Sports Vision Optometrist 152WS0006X T004397-1 NY Primary
Vision Therapy Optometrist 152WV0400X T004397-1 NY

Addresses

Primary practice location

274 W Main St
Victor, NY 14564-1157

Mailing address

7745 Peepers Holw
Victor, NY 14564-8914
Phone (585) 924-3688

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address fedmunds9682@direct.urmc.rochester.edu Direct
Direct Messaging Address fedmunds9682@direct.urmc.rochester.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200324000772 NY Practitioner - Ophthalmology 7315375466 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4397NYMDOptometrist
T004397-1NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Strong Eye Care CurrentSince Mar 1, 2020 Accepting new patients

Locations

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

601 Elmwood Ave
#659
Rochester, NY 14642
Phone (585) 275-0378

601 Elmwood Ave
#888
Rochester, NY 14642
Phone (585) 784-9582

Interoperability endpoints

  • Direct secure messaging: fedmunds9682@direct.urmc.rochester.edu

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1104991660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7745 PEEPERS HOLW",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145648914",
            "telephone_number": "585-924-3688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 W MAIN ST",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641157",
            "telephone_number": "585-880-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMUNDS",
        "first_name": "FREDERICK",
        "middle_name": "ROLLAND",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2023-07-06",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "4397",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "T004397-1",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NY",
            "license": "T004397-1",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "NY",
            "license": "T004397-1",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NY",
            "license": "T004397-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fedmunds9682@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "fedmunds9682@direct.urmc.rochester.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "601 Elmwood Ave",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146420001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Victor, NY

Sources for this page

Verify at the official NPI Registry.