Provider Demographics
NPI:1831378561
Name:EDWARD HENRY FRIES
Entity type:Organization
Organization Name:EDWARD HENRY FRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-627-2020
Mailing Address - Street 1:303 S WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1633
Mailing Address - Country:US
Mailing Address - Phone:940-627-2020
Mailing Address - Fax:940-627-1144
Practice Address - Street 1:303 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1633
Practice Address - Country:US
Practice Address - Phone:940-627-2020
Practice Address - Fax:940-627-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5685TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00852XMedicare PIN
TX5619980001Medicare NSC
TXDE6328Medicare PIN