Provider Demographics
NPI:1013960483
Name:FREY, CHRISTOPHER A (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:FREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SW PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8734
Mailing Address - Country:US
Mailing Address - Phone:772-878-3437
Mailing Address - Fax:772-878-1298
Practice Address - Street 1:514 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8734
Practice Address - Country:US
Practice Address - Phone:772-878-3437
Practice Address - Fax:772-878-1298
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4950OtherEVOLUTIONS HEALTHCARE SYS
FL50258OtherCOVENTRY HEALTH CARE
FL19515OtherBC/BS PROVIDER #
FL6599199OtherGHI PROVIDER #
FL539070OtherCOVENTRY HEALTH CARE
FLU86475Medicare UPIN
FLP00199044Medicare PIN
FLP00139950Medicare PIN
FLE6041WMedicare PIN
FLE6041XMedicare PIN