Provider Demographics
NPI:1215927769
Name:SCARPACE, FREDERICK WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:WILLIAM
Last Name:SCARPACE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25350 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2102
Mailing Address - Country:US
Mailing Address - Phone:313-563-2020
Mailing Address - Fax:313-274-1605
Practice Address - Street 1:25350 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2102
Practice Address - Country:US
Practice Address - Phone:313-563-2020
Practice Address - Fax:313-274-1605
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist