Provider Demographics
NPI:1679139315
Name:FRIDEGER, HEATHER RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RENEE
Last Name:FRIDEGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-1341
Mailing Address - Country:US
Mailing Address - Phone:567-644-8907
Mailing Address - Fax:
Practice Address - Street 1:1086 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8913
Practice Address - Country:US
Practice Address - Phone:937-492-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist