Provider Demographics
NPI:1982753281
Name:FRITTS, BRENDHAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDHAN
Middle Name:M
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 1:14 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4906
Mailing Address - Country:US
Mailing Address - Phone:580-255-1346
Mailing Address - Fax:580-255-1360
Practice Address - Street 1:14 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4906
Practice Address - Country:US
Practice Address - Phone:580-255-1346
Practice Address - Fax:580-255-1360
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1409539T152W00000X
OK2695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA3331Medicare PIN