Provider Demographics
NPI:1083687230
Name:FRYE, WILLIAM TRUMP (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TRUMP
Last Name:FRYE
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 1:321 MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-6213
Mailing Address - Country:US
Mailing Address - Phone:931-455-3262
Mailing Address - Fax:931-455-5467
Practice Address - Street 1:1802 N JACKSON ST
Practice Address - Street 2:STE# 830
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8218
Practice Address - Country:US
Practice Address - Phone:931-455-2020
Practice Address - Fax:931-455-5467
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN657152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT61162Medicare UPIN
TN3593884Medicare ID - Type Unspecified