Provider Demographics
NPI:1346310752
Name:FREWING, BERT ROGER (OD)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:ROGER
Last Name:FREWING
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 1:1602 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2506
Mailing Address - Country:US
Mailing Address - Phone:541-963-6224
Mailing Address - Fax:541-975-2114
Practice Address - Street 1:1602 4TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2506
Practice Address - Country:US
Practice Address - Phone:541-963-6224
Practice Address - Fax:541-975-2114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR972ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0000PGBPPMedicare ID - Type UnspecifiedMEDICARE NUMBER