Provider Demographics
NPI:1518111574
Name:FRIER, JILL (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:FRIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MAGARGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4066
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4066
Mailing Address - Country:US
Mailing Address - Phone:601-636-3937
Mailing Address - Fax:601-638-0944
Practice Address - Street 1:2152 IOWA BLVD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5572
Practice Address - Country:US
Practice Address - Phone:601-636-3937
Practice Address - Fax:601-638-0944
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2014-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B95-TA-806152W00000X
MS804152W00000X
NM603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00481340Medicaid
MS00481340Medicaid