Basic Information
| Provider Information | |||||||||
| NPI: | 1669968509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRONTINO | ||||||||
| FirstName: | LIZABETH | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208869 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753208869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362004393 | ||||||||
| FaxNumber: | 6365270766 | ||||||||
| Practice Location | |||||||||
| Address1: | 6756 RICHMOND HWY | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223066701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037681677 | ||||||||
| FaxNumber: | 7037656483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2018 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2072-T | KS | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618003109 | VA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG003412 | PA | N | Eye and Vision Services Providers | Optometrist |
No ID Information.