Individual
DR. PETER D FRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
777 TANGLEFOOT LN, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5694
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036082456
IL
207W00000X
Ophthalmology Physician
28136
IA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
036082456
IL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
28136
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060350
IA GROUP MEDICAID
IA
05
—
0084467
—
IA
01
—
26568
IA GROUP MEDICARE
IA
01
—
790730
IL GROUP MEDICARE
IL
Enumeration date
01/10/2006
Last updated
10/28/2024
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