Provider Demographics
NPI:1891777629
Name:FRIES, PATTI L (OD)
Entity Type:Individual
Prefix:DR
First Name:PATTI
Middle Name:L
Last Name:FRIES
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 1:11905 JAKE CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2745
Mailing Address - Country:US
Mailing Address - Phone:402-933-0439
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF OPHTHALMOLOGY AND VISUAL SCIENCES
Practice Address - Street 2:985540 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-0001
Practice Address - Country:US
Practice Address - Phone:402-559-4276
Practice Address - Fax:402-559-9392
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1188152W00000X
IA02310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist