Healthcare Provider Details

I. General information

NPI: 1043260797
Provider Name (Legal Business Name): BRETT ALLEN FREESE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 MAIN ST S
SAUK CENTRE MN
56378-1349
US

IV. Provider business mailing address

324 MAIN ST S
SAUK CENTRE MN
56378-4885
US

V. Phone/Fax

Practice location:
  • Phone: 320-352-3026
  • Fax: 320-352-1164
Mailing address:
  • Phone: 320-352-3026
  • Fax: 320-352-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2352
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: