Provider Demographics
NPI:1609018126
Name:FRIES EYE CARE, LLC
Entity Type:Organization
Organization Name:FRIES EYE CARE, LLC
Other - Org Name:PROFESSIONAL EYE CARE AT WESTAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-895-9955
Mailing Address - Street 1:484 COUNTY LINE RD W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7080
Mailing Address - Country:US
Mailing Address - Phone:614-895-9955
Mailing Address - Fax:614-895-8826
Practice Address - Street 1:484 COUNTY LINE RD W
Practice Address - Street 2:SUITE 120
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7080
Practice Address - Country:US
Practice Address - Phone:614-895-9955
Practice Address - Fax:614-895-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty