Provider Demographics
NPI:1033302294
Name:MELVIN L. FRECKER O.D.
Entity type:Organization
Organization Name:MELVIN L. FRECKER O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-664-7647
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-0479
Mailing Address - Country:US
Mailing Address - Phone:765-664-7647
Mailing Address - Fax:765-668-1495
Practice Address - Street 1:304 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3528
Practice Address - Country:US
Practice Address - Phone:765-664-7647
Practice Address - Fax:765-668-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002023B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0596930001OtherDMEPOS
IN0596930001OtherDMEPOS