Provider Demographics
NPI:1730165267
Name:J MICHAEL FRISCHE OD PC
Entity type:Organization
Organization Name:J MICHAEL FRISCHE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRISCHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-523-6100
Mailing Address - Street 1:300 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2148
Mailing Address - Country:US
Mailing Address - Phone:812-523-6100
Mailing Address - Fax:812-523-6538
Practice Address - Street 1:300 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2148
Practice Address - Country:US
Practice Address - Phone:812-523-6100
Practice Address - Fax:812-523-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000190A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0373830001Medicare NSC
T-34728Medicare UPIN