MEDICARE: DR. TRACI ANN 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	02115	IA

General Provider Information

NPI Number	:	1851364921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACI ANN FRIEDMAN OD

Provider Business Mailing Address
First Line	:	905 W. BRIDGE ROAD
Second Line	:	SUITE 1
City	:	POLK CITY
State	:	IA
Zip	:	50226
Country	:	US
Telephone Number	:	515-329-6454
Fax Number	:	515-984-3436

Provider Business Practice Location Address
First Line	:	905 W. BRIDGE ROAD
Second Line	:	SUITE 1
City	:	POLK CITY
State	:	IA
Zip	:	50226
Country	:	US
Telephone Number	:	515-329-6454
Fax Number	:	515-984-3436

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	04/14/2017

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