Provider Demographics
NPI:1356348783
Name:AFFORDABLE PRICE VISION CTR INC
Entity type:Organization
Organization Name:AFFORDABLE PRICE VISION CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-632-9749
Mailing Address - Street 1:2700 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-1806
Mailing Address - Country:US
Mailing Address - Phone:405-632-9749
Mailing Address - Fax:405-632-6331
Practice Address - Street 1:2700 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-1806
Practice Address - Country:US
Practice Address - Phone:405-632-9749
Practice Address - Fax:405-632-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-10-01
Deactivation Date:2006-02-13
Deactivation Code:
Reactivation Date:2006-02-22
Provider Licenses
StateLicense IDTaxonomies
OK809332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762240BMedicaid
OK200007160AMedicaid
OK100805490CMedicaid
OK200106360AMedicaid
OK200106360AMedicaid
OK900522067Medicare PIN
OK0187530001Medicare NSC
OK249605401Medicare PIN
OK245621501Medicare PIN
OK100762240BMedicaid
OK249605401Medicare ID - Type UnspecifiedCHRIS J FRY O D
OK249611805Medicare ID - Type UnspecifiedTERRESA HARRINGTON O D
OK200007160AMedicaid