Provider Demographics
NPI:1902891971
Name:NEISTADT, FREDERIC A (OD)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:A
Last Name:NEISTADT
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 1:2200 W HAMILTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6337
Mailing Address - Country:US
Mailing Address - Phone:610-437-0717
Mailing Address - Fax:610-437-3741
Practice Address - Street 1:2200 W HAMILTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6337
Practice Address - Country:US
Practice Address - Phone:610-437-0717
Practice Address - Fax:610-437-3741
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA235326OtherUNITED HEALTHCARE
PA391267OtherNVA
PA2394OtherAETNA US HEALTHCARE
PA52295OtherDAVIS VISION
PA01746001OtherCAPITAL BLUE CROSS
PANE286510OtherHIGHMARK BLUE SHIELD
PANE286510OtherHIGHMARK BLUE SHIELD
PA52295OtherDAVIS VISION
PAU07971Medicare UPIN