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General NPI Number Information
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NPI Number | 1356535538
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Entity Type | Organization
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Legal Business Name | FAMILY OPTOMETRY GROUP
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 4976 VERDUGO WAY
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City | CAMARILLO
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State | CA
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Zip | 93012-8632
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Country | US
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Telephone | 805-482-4628
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Fax | 805-482-4620
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Provider Business Mailing Address
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Address Line | 4976 VERDUGO WAY
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City | CAMARILLO
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State | CA
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Zip | 93012-8632
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Country | US
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Telephone | 805-482-4628
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Fax | 805-482-4620
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL BRIAN FREELAND
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Credential | O.D.
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Telephone | 805-482-4628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10886T
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License Number State | CA
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