1942998869 NPI number — FREELAND VISION LLC

Table of content: (NPI 1942998869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942998869 NPI number — FREELAND VISION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREELAND VISION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942998869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 SWEET BAY CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-380-5486
Provider Business Mailing Address Fax Number:
937-956-7708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1085 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-505-8585
Provider Business Practice Location Address Fax Number:
937-956-7708
Provider Enumeration Date:
04/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FREELAND
Authorized Official First Name:
KLAUS
Authorized Official Middle Name:
Authorized Official Title or Position:
OPHTHALMOLOGIST/OWNER
Authorized Official Telephone Number:
941-380-5486

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0017866 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com