Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 743 | SD |
NPI | 1013401637 |
---|---|
Provider Name | Dr. Jarrell Freitag |
First Address | Sioux Falls, SD 57106-4331 |
Second Address | Sioux Falls, SD 57106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 24/09/2018 |