Healthcare Provider Details

I. General information

NPI: 1578318028
Provider Name (Legal Business Name): COURAGEOUS OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LEE BLVD STE K02
YORKTOWN HEIGHTS NY
10598-1160
US

IV. Provider business mailing address

144 HIGH POINT CIR
NEWBURGH NY
12550-7243
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-8111
  • Fax:
Mailing address:
  • Phone: 845-728-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW FREILICH
Title or Position: MEMBER
Credential: OD
Phone: 845-728-2802