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General NPI Number Information
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NPI Number | 1437517968
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Entity Type | Organization
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Legal Business Name | MICHELLE L. FRYE, O.D. LLC
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 902 W WAYNE ST
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City | FORT WAYNE
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State | IN
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Zip | 46802-3976
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Country | US
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Telephone | 260-422-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 2324 COUNTY ROAD 56
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City | AUBURN
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State | IN
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Zip | 46706-9507
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Country | US
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Telephone | 260-925-4893
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE FRYE
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Credential | O.D.
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Telephone | 604-229-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 18003461B
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License Number State | IN
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