Organization
FREDERICK CUSTOMEYEZ PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FREDERICK (OWNER)
(401) 584-3939
Entity
Organization
Contact information
Practice address
1834 CRAIG RD, SAINT LOUIS, MO 63146-4712
(401) 584-3939
(216) 678-9186
Mailing address
PO BOX 27802, SAINT LOUIS, MO 63146-1302
(401) 584-3939
(216) 678-9186
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
07/26/2022
Last updated
10/29/2025
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