Provider Demographics
NPI:1538227798
Name:FRIE, NATALEE Z (OD)
Entity type:Individual
Prefix:
First Name:NATALEE
Middle Name:Z
Last Name:FRIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NATALEE
Other - Middle Name:Z
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3063 MEADOWLARK LN STE 10
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2660
Mailing Address - Country:US
Mailing Address - Phone:155-141-2897
Mailing Address - Fax:715-514-1290
Practice Address - Street 1:3063 MEADOWLARK LN STE 10
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2660
Practice Address - Country:US
Practice Address - Phone:155-141-2897
Practice Address - Fax:715-514-1290
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2951-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU97728Medicare UPIN