Provider Demographics
NPI:1881198869
Name:FRITZ, ASHLEY KAYE (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:KAYE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56847 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9615
Mailing Address - Country:US
Mailing Address - Phone:269-273-2020
Mailing Address - Fax:269-279-6010
Practice Address - Street 1:56847 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9615
Practice Address - Country:US
Practice Address - Phone:269-273-2020
Practice Address - Fax:269-279-6010
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006636152W00000X
MI4901005237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist