Provider Demographics
NPI:1104991660
Name:EDMUNDS, FREDERICK ROLLAND JR (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROLLAND
Last Name:EDMUNDS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 PEEPERS HOLW
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8914
Mailing Address - Country:US
Mailing Address - Phone:585-924-3688
Mailing Address - Fax:
Practice Address - Street 1:274 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1157
Practice Address - Country:US
Practice Address - Phone:585-880-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4397152W00000X
NYT004397-1152W00000X, 152WC0802X, 152WV0400X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy