Provider Demographics
NPI:1497747687
Name:FRISBEY, WES L (OD)
Entity Type:Individual
Prefix:MR
First Name:WES
Middle Name:L
Last Name:FRISBEY
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:E6112 E BLUFFVIEW RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1436
Mailing Address - Fax:906-932-0644
Practice Address - Street 1:E6112 E BLUFFVIEW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-1436
Practice Address - Fax:906-932-0644
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4918147Medicaid
WI38630300Medicaid
MI900B710210OtherBCBS OF MICHIGAN
MI0P14470002Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
MI4918147Medicaid
MIT33322Medicare UPIN