Basic Information
| Provider Information | |||||||||
| NPI: | 1972560407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTHERLAND | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953650 | ||||||||
| FaxNumber: | 7042953666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 32212 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 10478 | 01 | NC | KANAWHA | OTHER | 376583 | 01 | NC | MAMSI | OTHER | 11092 | 01 | NC | BCBS MEDPOINT | OTHER | 000000295033 | 01 | SC | UNISON HEALTH PLAN SC | OTHER | 100705 | 01 | NC | WELLNESS | OTHER | 20093347 | 01 | SC | SELECT HEALTH OF SC | OTHER | N32212 | 05 | SC | MEDICAID | 180021443 | 01 | RAILROAD MEDICARE | OTHER | 36362 | 01 | NC | MEDCOST | OTHER | 141018 | 01 | NC | COVENTRY | OTHER | 2630782002 | 01 | NC | CIGNA | OTHER | 81056 | 01 | NC | BCBS | OTHER | 6182 | 01 | NC | DOCTORS HEALTH PLAN | OTHER | 6679 | 01 | NC | PARTNERS | OTHER | 7472 | 01 | NC | WELLPATH | OTHER | 0841437 | 01 | NC | UNITED HEALTHCARE | OTHER | 4116519 | 01 | NC | AETNA | OTHER | 8981056 | 05 | NC | MEDICAID |