1114939378 NPI number — FRIEDRICHS FAMILY EYE CENTER PC

Table of content: JUNE PARK M.D. (NPI 1285088302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114939378 NPI number — FRIEDRICHS FAMILY EYE CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIEDRICHS FAMILY EYE CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114939378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1975 VIRGINIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24112-8388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-647-3937
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1975 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24112-8388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-647-3937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDRICHS
Authorized Official First Name:
GRAY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
276-647-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618001415 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0618001335 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0618000917 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010108641 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093800781 . This is a "CHRISTAIN NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114928934 . This is a "DR. BUTTERWORTH'S NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1568515666 . This is a "NPI - DR. HARPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1174526008 . This is a "DR. FRIEDRICHS' NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010063272 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010070155 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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