Healthcare Provider Details

I. General information

NPI: 1497747687
Provider Name (Legal Business Name): WES L FRISBEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E6112 E BLUFFVIEW RD SUITE 102
IRONWOOD MI
49938-9622
US

IV. Provider business mailing address

E6112 E BLUFFVIEW RD SUITE 102
IRONWOOD MI
49938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 906-932-1436
  • Fax: 906-932-0644
Mailing address:
  • Phone: 906-932-1436
  • Fax: 906-932-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003062
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: