Provider Demographics
NPI:1861566242
Name:FRYER, MICHAEL R
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:FRYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1332
Mailing Address - Country:US
Mailing Address - Phone:585-392-6610
Mailing Address - Fax:585-392-5613
Practice Address - Street 1:50 EAST AVE
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1332
Practice Address - Country:US
Practice Address - Phone:585-392-6610
Practice Address - Fax:585-392-5613
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP010005111152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0198490001Medicare NSC
NY15066CMedicare PIN