MEDICARE: DR. STUART ADDIS FRIEDMAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3978	NY

General Provider Information

NPI Number	:	1497831846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART ADDIS FRIEDMAN OD

Provider Business Mailing Address
First Line	:	132 MONTAGUE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3521
Country	:	US
Telephone Number	:	718-852-1149
Fax Number	:	718-522-4379

Provider Business Practice Location Address
First Line	:	132 MONTAGUE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3521
Country	:	US
Telephone Number	:	718-852-1149
Fax Number	:	718-522-4379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	02/07/2012

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