Provider Demographics
NPI:1013029198
Name:FRIES, EDWARD HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HENRY
Last Name:FRIES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1633
Mailing Address - Country:US
Mailing Address - Phone:940-627-2020
Mailing Address - Fax:940-627-1144
Practice Address - Street 1:303 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1633
Practice Address - Country:US
Practice Address - Phone:940-627-2020
Practice Address - Fax:940-627-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5685TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMF1366663OtherDEA
TXV02975Medicare UPIN
TX8D0133Medicare PIN