Healthcare Provider Details

I. General information

NPI: 1881741213
Provider Name (Legal Business Name): AMY JEAN FREED O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 WHITE OAK DR
CHASKA MN
55318-2525
US

IV. Provider business mailing address

4004 HALLGREN CT
EXCELSIOR MN
55331-7755
US

V. Phone/Fax

Practice location:
  • Phone: 952-466-3937
  • Fax: 952-466-3936
Mailing address:
  • Phone: 612-554-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2626
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: