Organization
FREDERICK CUSTOMEYEZ PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FREDERICK (OCULARIST/OWNER)
(401) 584-3939
Entity
Organization
Contact information
Practice address
1422 EUCLID AVE, SUITE 802, CLEVELAND, OH 44115-1902
(401) 584-3939
Mailing address
9278 PARADISE DR, PANAMA CITY BEACH, FL 32413-9625
(401) 584-3939
(216) 678-9186
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
O.24
OH
Other
Enumeration date
11/26/2016
Last updated
07/03/2025
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