Provider Demographics
NPI:1295711836
Name:FRY, CHRIS J (OD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:J
Last Name:FRY
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 1:6303 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
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200007160BMedicaid
OK249605401OtherAFFORDABLE PRICE VISION CTR., INC. MEDICARE
OKU11167Medicare UPIN
OK200007160BMedicaid
OK$$$$$$$$$PMedicare PIN