Provider Demographics
NPI:1164440335
Name:FREY, GREGORY M (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:FREY
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 1:404 BELLFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6803
Mailing Address - Country:US
Mailing Address - Phone:214-668-1836
Mailing Address - Fax:
Practice Address - Street 1:600 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4508
Practice Address - Country:US
Practice Address - Phone:972-223-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5638TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159443402Medicaid
TX8F4209Medicare PIN
TXU72391Medicare UPIN