Provider Demographics
NPI:1699109256
Name:FREY VISION GROUP OF INDIANA INC
Entity type:Organization
Organization Name:FREY VISION GROUP OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRUEX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-484-2691
Mailing Address - Street 1:3409 N ANTHONY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2233
Mailing Address - Country:US
Mailing Address - Phone:260-484-2691
Mailing Address - Fax:260-484-0616
Practice Address - Street 1:3409 N ANTHONY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-2233
Practice Address - Country:US
Practice Address - Phone:260-484-2691
Practice Address - Fax:260-484-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002970A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300003662Medicaid