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General NPI Number Information
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NPI Number | 1407141906
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Entity Type | Organization
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Legal Business Name | FRIES EYE CARE, LLC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 207 GLENN AVE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1711
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Country | US
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Telephone | 740-335-2020
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Fax | 740-335-1025
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Provider Business Mailing Address
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Address Line | 207 GLENN AVE
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1711
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Country | US
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Telephone | 740-335-2020
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Fax | 740-335-1025
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY D FRIES
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Credential | O.D.
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Telephone | 740-335-2020
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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 | 5472
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License Number State | OH
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