1619049509 NPI number — FREDRICK FEIL OD

Table of content: FREDRICK FEIL OD (NPI 1619049509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619049509 NPI number — FREDRICK FEIL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEIL
Provider First Name:
FREDRICK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1619049509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-258-3101
Provider Business Mailing Address Fax Number:
530-258-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-258-3101
Provider Business Practice Location Address Fax Number:
530-258-2020
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT9579TPG , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SD0095790 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com