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NPI Code Detail

MEDICARE: JEFFREY A FRIES OD

MEDICARE: JEFFREY A FRIES OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3445WA
2152W00000XOptometristOD00003445WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407821499
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY A FRIES OD
Provider Business Mailing Address
First Line : 500 NE MULTNOMAH ST STE 100
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2031
Country : US
Telephone Number : 503-813-4756
Fax Number : 877-821-5101
Provider Business Practice Location Address
First Line : 1230 7TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3166
Country : US
Telephone Number : 877-213-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 02/04/2022

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Directions to “ JEFFREY A FRIES OD” Practice Location

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