Provider Demographics
NPI:1659390367
Name:FRYE, TIMOTHY A (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:FRYE
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 1:1289 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1392
Mailing Address - Country:US
Mailing Address - Phone:740-412-3661
Mailing Address - Fax:
Practice Address - Street 1:1289 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1392
Practice Address - Country:US
Practice Address - Phone:740-412-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU73127Medicare UPIN
OHFR0861082Medicare ID - Type UnspecifiedNON PAR