NPIMap

Organization Active NPI

Frederick Customeyez Prosthetics LLC

  • Ocularist
  • Saint Louis, MO
National Provider Identifier
1841926599
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OcularistTaxonomy code 156FX1700X
Legal business name
FREDERICK CUSTOMEYEZ PROSTHETICS LLC
Practice address
1834 Craig Rd
Saint Louis, MO 63146-4712
Phone
(401) 584-3939
Fax
(216) 678-9186
NPI assigned
Jul 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

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

Authorized official

Name
Melissa FrederickNPI 1679047609
Title
Owner
Phone
(401) 584-3939

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OcularistGroup: 193400000X SINGLE SPECIALTY GROUP 156FX1700X Primary
Customized Equipment (DME) 332BC3200X
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

1834 Craig Rd
Saint Louis, MO 63146-4712

Mailing address

PO Box 27802
Saint Louis, MO 63146-1302
Phone (401) 584-3939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220829001325 MO DME Supplier - OcularistDME Supplier - Optician 0042594244 Practice locations: Saint Louis, MO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Frederick Customeyez Prosthetics LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1422 Euclid Ave
Ste 618
Cleveland, OH 44115
Phone (401) 584-3939

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1841926599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27802",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631461302",
            "telephone_number": "401-584-3939",
            "fax_number": "216-678-9186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 CRAIG RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464712",
            "telephone_number": "401-584-3939",
            "fax_number": "216-678-9186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK CUSTOMEYEZ PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-26",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-584-3939"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Ocularist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.