Healthcare Provider Details

I. General information

NPI: 1669391645
Provider Name (Legal Business Name): TAYLOR MARIE FREESEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 ASHWORTH RD
WEST DES MOINES IA
50266-7143
US

IV. Provider business mailing address

5970 ASHWORTH RD
WEST DES MOINES IA
50266-7143
US

V. Phone/Fax

Practice location:
  • Phone: 515-440-4610
  • Fax: 515-440-4611
Mailing address:
  • Phone: 515-440-4610
  • Fax: 515-440-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number139315
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: