# DR. FREDERICK ROLLAND EDMUNDS JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1104991660
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 4397 | NY | — |
| 152W00000X | Optometrist | T004397-1 | NY | — |
| 152WC0802X | Corneal and Contact Management Optometrist | T004397-1 | NY | — |
| 152WS0006X | Sports Vision Optometrist | T004397-1 | NY | Yes |
| 152WV0400X | Vision Therapy Optometrist | T004397-1 | NY | — |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 07/06/2023