Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4893 | MA |
NPI | 1194992461 |
---|---|
Provider Name | Dr. Gary J Freedman |
First Address | Marblehead, MA 01945-3045 |
Second Address | Marblehead, MA 01945-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 14/05/2008 |