1184863334 NPI number — BRENDHAN M. FRITTS OD PC

Table of content: (NPI 1184863334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184863334 NPI number — BRENDHAN M. FRITTS OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENDHAN M. FRITTS OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184863334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 S 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNCAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73533-4906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-255-1346
Provider Business Mailing Address Fax Number:
580-255-1360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73533-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-255-1346
Provider Business Practice Location Address Fax Number:
580-255-1360
Provider Enumeration Date:
02/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRITTS
Authorized Official First Name:
BRENDHAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
580-255-1346

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2695 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X , with the licence number: 6860T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)