Individual
GARY W. FREDERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
120 KINGS WAY, SUITE 1300, WILLIAMSBURG, VA 23185-2505
(757) 345-3001
(757) 345-3102
Mailing address
856 J CLYDE MORRIS BLVD, SUITE A, NEWPORT NEWS, VA 23601-1318
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000905
VA
Other
Enumeration date
04/27/2006
Last updated
11/27/2013
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