Provider Demographics
NPI:1437517968
Name:MICHELLE L. FRYE, O.D. LLC
Entity Type:Organization
Organization Name:MICHELLE L. FRYE, O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:604-229-4221
Mailing Address - Street 1:2324 COUNTY ROAD 56
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9507
Mailing Address - Country:US
Mailing Address - Phone:260-925-4893
Mailing Address - Fax:
Practice Address - Street 1:902 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3976
Practice Address - Country:US
Practice Address - Phone:260-422-9421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHELLE L. FRYE, O.D. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003461B261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN218500COtherMEDICARE
IN201344210Medicaid