Individual
DR. JOHN CHARLES FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 TANGLEFOOT LN, EYE SURGEONS ASSOCIATES PC, BETTENDORF, IA 52722
(563) 323-2020
(563) 328-5694
Mailing address
777 TANGLEFOOT LN, EYE SURGEONS ASSOCIATES PC, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5694
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-098033
IL
207W00000X
Ophthalmology Physician
32467
IA
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
036-098033
IL
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
32467
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060350
IA GROUP MEDICAID
IA
05
—
0170860
—
IA
05
—
036098033
—
IL
01
—
26568
IA GROUP MEDICARE
IA
01
—
790730
IL GROUP MEDICARE
IL
Enumeration date
12/28/2005
Last updated
08/14/2018
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