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General NPI Number Information
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NPI Number | 1912253758
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Entity Type | Organization
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Legal Business Name | FREEMAN EYE CARE PLLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 77 NORMAN MORGAN BLVD
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City | LOGAN
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State | WV
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Zip | 25601-3477
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Country | US
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Telephone | 304-752-5659
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Fax | 304-752-6329
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Provider Business Mailing Address
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Address Line | 519 2ND ST W
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City | MADISON
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State | WV
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Zip | 25130-1043
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Country | US
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Telephone | 304-752-5659
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Fax | 304-752-6329
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY DALE FREEMAN
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Credential | O.D.
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Telephone | 304-752-5659
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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 | 1003-OD
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License Number State | WV
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