Provider Demographics
NPI:1821263237
Name:STEPHEN L FRICKE ODPC
Entity Type:Organization
Organization Name:STEPHEN L FRICKE ODPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-446-3171
Mailing Address - Street 1:316 W 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2008
Mailing Address - Country:US
Mailing Address - Phone:918-446-3171
Mailing Address - Fax:
Practice Address - Street 1:316 W 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2008
Practice Address - Country:US
Practice Address - Phone:918-446-3171
Practice Address - Fax:918-446-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK865261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK238518701Medicare PIN