Provider Demographics
NPI:1760608509
Name:CHRIS J FRY O D, INC
Entity Type:Organization
Organization Name:CHRIS J FRY O D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-782-0300
Mailing Address - Street 1:6303 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5931
Mailing Address - Country:US
Mailing Address - Phone:405-782-0300
Mailing Address - Fax:405-782-0302
Practice Address - Street 1:6303 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5931
Practice Address - Country:US
Practice Address - Phone:405-782-0300
Practice Address - Fax:405-782-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1133152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU11167Medicare UPIN