Individual
ROBERT FRIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
PO BOX 800, FAIRMONT, MN 56031-0800
(507) 238-8555
Mailing address
800 MEDICAL CENTER DR, PO BOX 800, FAIRMONT, MN 56031-4575
(507) 238-8555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2353
MN
207W00000X
Ophthalmology Physician
2353
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114854
—
MN
05
—
1160887
—
IA
01
—
22-02567
MEDICA
MN
05
—
441525600
—
MN
01
—
573R3FR
BLUE CROSS
MN
05
—
573R3FR
—
MN
01
—
675185
ARAZ
MN
01
—
MH9041028502
PREFERRED ONE
MN
Enumeration date
12/06/2005
Last updated
07/21/2022
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