Provider Demographics
NPI:1346321205
Name:FRIEND, D. DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:DOUGLAS
Last Name:FRIEND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:DOUGLAS
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1354 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2552
Mailing Address - Country:US
Mailing Address - Phone:937-335-6453
Mailing Address - Fax:937-335-1767
Practice Address - Street 1:1354 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2552
Practice Address - Country:US
Practice Address - Phone:937-335-6453
Practice Address - Fax:937-335-1767
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3602/T919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0499009Medicaid
OH0544901Medicare ID - Type Unspecified
OHT48007Medicare UPIN
OH0377310001Medicare NSC