Individual provider Active NPI

Gregory M Frey, O.D.

  • Optometrist
  • Desoto, TX
National Provider Identifier
1164440335
Registry record updated Jan 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5638TG Issued in TX
Practice address
600 N Hampton Rd
Desoto, TX 75115-4508
Phone
(972) 223-5354
NPI assigned
Jul 17, 2006
Last updated
Jan 26, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5638TG TX Primary

Addresses

Primary practice location

600 N Hampton Rd
Desoto, TX 75115-4508

Mailing address

404 Bellflower CT
Mansfield, TX 76063-6803
Phone (214) 668-1836

Other identifiers 1

IdentifierTypeStateIssuer
159443402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5638TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Visioncare of Mansfield PA Optometrist Past Accepting new patients
Advanced Visioncare PastSince Nov 5, 2015 Accepting new patients
20/20 Icare and Iwear, PLLC Optometrist PastSince Mar 8, 2018 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1164440335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 BELLFLOWER CT",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760636803",
            "telephone_number": "214-668-1836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N HAMPTON RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751154508",
            "telephone_number": "972-223-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREY",
        "first_name": "GREGORY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5638TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159443402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.