MEDICARE: DR. MICHAEL ALAN FREGGER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC1985	FL

General Provider Information

NPI Number	:	1316942311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALAN FREGGER O.D.

Provider Business Mailing Address
First Line	:	17 RACETRACK RD NW
Second Line	:	STE A
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-4607
Country	:	US
Telephone Number	:	850-862-9595
Fax Number	:	850-862-0099

Provider Business Practice Location Address
First Line	:	17 RACETRACK RD NW
Second Line	:	STE A
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-4607
Country	:	US
Telephone Number	:	850-862-9595
Fax Number	:	850-862-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/18/2010

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