Provider Demographics
NPI:1144366964
Name:FREY, ROGER (LDO)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:FREY
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3668
Mailing Address - Country:US
Mailing Address - Phone:813-977-4801
Mailing Address - Fax:813-979-4572
Practice Address - Street 1:1410 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3668
Practice Address - Country:US
Practice Address - Phone:813-977-4801
Practice Address - Fax:813-979-4572
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2954156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician