Provider Demographics
NPI:1841864725
Name:FRITTS, WILLIAM DANE (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANE
Last Name:FRITTS
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 1:137 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1701
Mailing Address - Country:US
Mailing Address - Phone:859-398-0602
Mailing Address - Fax:
Practice Address - Street 1:137 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1701
Practice Address - Country:US
Practice Address - Phone:606-783-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2220DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist