Provider Demographics
NPI:1124049499
Name:FRY EYE ASSOCIATES PA
Entity type:Organization
Organization Name:FRY EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-275-7248
Mailing Address - Street 1:502 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6183
Mailing Address - Country:US
Mailing Address - Phone:620-275-7248
Mailing Address - Fax:620-275-5262
Practice Address - Street 1:502 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6183
Practice Address - Country:US
Practice Address - Phone:620-275-7248
Practice Address - Fax:620-275-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100722450AMedicaid
CO94001922Medicaid
KS100215250AMedicaid
KS100215250AMedicaid
CO94001922Medicaid