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General NPI Number Information
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NPI Number | 1336412790
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Entity Type | Organization
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Legal Business Name | RICHARD E. FRY, OD, PA
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 110 S THOMAS ST
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City | BEULAVILLE
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State | NC
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Zip | 28518-8810
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Country | US
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Telephone | 910-298-3001
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Fax | 910-298-8149
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Provider Business Mailing Address
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Address Line | 110 S THOMAS ST
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City | BEULAVILLE
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State | NC
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Zip | 28518-8810
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Country | US
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Telephone | 910-298-3001
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Fax | 910-298-8149
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | RICHARD FRY
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Credential | O.D.
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Telephone | 910-298-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1189
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License Number State | NC
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