Individual provider Active NPI

Gary M Frick, OD

  • Optometrist
  • Ventura, CA
National Provider Identifier
1962498030
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7188T Issued in CA
Practice address
10225 Telephone Rd
Suite E
Ventura, CA 93004-2804
Phone
(805) 647-4950
Fax
(805) 647-4969
NPI assigned
Sep 23, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7188T CA Primary

Addresses

Primary practice location

10225 Telephone Rd
Suite E
Ventura, CA 93004-2804

Mailing address

10225 Telephone Rd
Suite E
Ventura, CA 93004-2804
Phone (805) 647-4950

Other identifiers 1

IdentifierTypeStateIssuer
SD0071880MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100309000144 CA Practitioner - Optometry 5496890972 Practice locations: Ventura, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7188TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Debon Crews, Optometric Corporation Optometrist PastSince Aug 7, 2022 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207785600000",
    "number": "1962498030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10225 TELEPHONE RD",
            "address_2": "SUITE E",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930042804",
            "telephone_number": "805-647-4950",
            "fax_number": "805-647-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10225 TELEPHONE RD",
            "address_2": "SUITE E",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930042804",
            "telephone_number": "805-647-4950",
            "fax_number": "805-647-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRICK",
        "first_name": "GARY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2008-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7188T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0071880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.