Individual
FREDERIC A BANSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2842 N SHERIDAN RD, CHICAGO, IL 60657-6174
(773) 975-4300
(773) 661-1767
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(866) 795-4020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
036095121
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001618089
BC
—
01
—
0342700001
DME
—
05
—
046007551
—
IL
01
—
778910
MEDICARE GROUP #
IL
Enumeration date
11/27/2006
Last updated
07/25/2019
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