Provider Demographics
NPI:1184863334
Name:BRENDHAN M. FRITTS OD PC
Entity Type:Organization
Organization Name:BRENDHAN M. FRITTS OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-255-1346
Mailing Address - Street 1:14 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4906
Mailing Address - Country:US
Mailing Address - Phone:580-255-1346
Mailing Address - Fax:580-255-1360
Practice Address - Street 1:14 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4906
Practice Address - Country:US
Practice Address - Phone:580-255-1346
Practice Address - Fax:580-255-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2695152W00000X
TX6860T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA3332Medicare PIN