Provider Demographics
NPI:1417238502
Name:FRIE OPTOMETRY LLC
Entity Type:Organization
Organization Name:FRIE OPTOMETRY LLC
Other - Org Name:VISIONARY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALEE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:FRIE
Authorized Official - Suffix:
Authorized Official - Credentials:OS
Authorized Official - Phone:715-514-1289
Mailing Address - Street 1:3063 MEADOWLARK LANE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720
Mailing Address - Country:US
Mailing Address - Phone:715-514-1289
Mailing Address - Fax:715-514-1290
Practice Address - Street 1:3063 MEADOWLARK LANE
Practice Address - Street 2:SUITE 10
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:715-514-1289
Practice Address - Fax:715-514-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2951-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU97728Medicare UPIN