Provider Demographics
NPI:1851675441
Name:KENNETH C. FRIES, O.D., P.C.
Entity type:Organization
Organization Name:KENNETH C. FRIES, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-272-6121
Mailing Address - Street 1:PO BOX 14116
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1116
Mailing Address - Country:US
Mailing Address - Phone:912-272-6121
Mailing Address - Fax:912-691-1277
Practice Address - Street 1:412 US HIGHWAY 80 SW
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2541
Practice Address - Country:US
Practice Address - Phone:912-748-3937
Practice Address - Fax:912-748-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-01
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAOPT001492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty