Provider Demographics
NPI:1720048838
Name:FREY, ALVIN LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:LEWIS
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 1:4495 ATLANTA HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6736
Mailing Address - Country:US
Mailing Address - Phone:770-554-3456
Mailing Address - Fax:770-554-3458
Practice Address - Street 1:4495 ATLANTA HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6736
Practice Address - Country:US
Practice Address - Phone:770-554-3456
Practice Address - Fax:770-554-3458
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000716185BMedicaid
GA41ZCDSXMedicare ID - Type Unspecified
GAT93706Medicare UPIN