Provider Demographics
NPI:1326181926
Name:FREDERICK W. SCARPACE O.D. P.C.
Entity type:Organization
Organization Name:FREDERICK W. SCARPACE O.D. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCARPACE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:313-563-2020
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q24627Medicare PIN
MI0183240002Medicare NSC