Provider Demographics
NPI:1861509051
Name:JOSEPH E FRYDMAN, MD,SC
Entity type:Organization
Organization Name:JOSEPH E FRYDMAN, MD,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-336-7797
Mailing Address - Street 1:2634 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2460
Mailing Address - Country:US
Mailing Address - Phone:847-336-7797
Mailing Address - Fax:847-336-9860
Practice Address - Street 1:2634 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2460
Practice Address - Country:US
Practice Address - Phone:847-336-7797
Practice Address - Fax:847-336-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036037979156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036037979Medicaid
ILC41256Medicare UPIN
IL0156220001Medicare NSC
IL456201Medicare ID - Type Unspecified