Fredric C Devries OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901002219 Issued in MI

Legal business name

FREDRIC C DEVRIES OD PC

Practice address

3050 Ivanrest Ave SW
Grandville, MI 49418-1400

Phone

(616) 538-0150

Fax

(616) 538-3954

NPI assigned

Oct 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Fredric Carl Devries, O.D., F.A.A.O.

Title

President

Phone

(616) 538-0150

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1962592758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2711 BYRON STATION DR SW",
            "city": "BYRON CENTER",
            "state": "MI",
            "postal_code": "493159458",
            "telephone_number": "616-583-0404",
            "fax_number": "616-583-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 IVANREST AVE SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181400",
            "telephone_number": "616-538-0150",
            "fax_number": "616-538-3954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDRIC C DEVRIES OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "FREDRIC",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-538-0150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D., F.A.A.O."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0D16540",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "0D16540",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Asia Monea Forbes
• Mary Lynn Ford, BT
• Sherry Lynn France, LMSW
• Lee David Frederickson, DDS
• Ryan Frederickson, D.D.S.
• Cynthia J Freeney
• Fuel Health & Wellness - Grandville, PLLC
• Barbara K Fulton, MD
• Jessica Nicole Gabert
• Mackenzie Galbreath

• Optometrist in Grandville, MI
• Providers in Grandville, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.