Organization
MELVIN L. FRECKER O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELVIN FRECKER O.D. (OWNER)
(765) 664-7647
Entity
Organization
Contact information
Practice address
304 S BALDWIN AVE, MARION, IN 46952-3528
(765) 664-7647
(765) 668-1495
Mailing address
PO BOX 479, MARION, IN 46952-0479
(765) 664-7647
(765) 668-1495
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002023B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0596930001
DMEPOS
IN
Enumeration date
08/21/2007
Last updated
08/21/2007
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