Organization
IVY ELAINE FREDERICK, OD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVY FREDERICK (OPTOMITRIST)
(724) 924-1799
Entity
Organization
Contact information
Practice address
2501 W STATE ST, NEW CASTLE, PA 16101-1039
(724) 657-9686
Mailing address
2242 CENTER CHURCH RD, ELLWOOD CITY, PA 16117-7804
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG002192
PA
Other
Enumeration date
06/13/2009
Last updated
06/28/2009
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