Provider Demographics
NPI:1710396627
Name:FREY, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 W ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2218
Mailing Address - Country:US
Mailing Address - Phone:218-728-6211
Mailing Address - Fax:218-724-1833
Practice Address - Street 1:2186 MONARCH DR
Practice Address - Street 2:
Practice Address - City:WRENSHALL
Practice Address - State:MN
Practice Address - Zip Code:55797-9110
Practice Address - Country:US
Practice Address - Phone:218-348-1169
Practice Address - Fax:715-392-6222
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3361152W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No152W00000XEye and Vision Services ProvidersOptometrist