Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OE-008157-P | PA |
NPI | 1265481998 |
---|---|
Provider Name | Kathleen Fraser Freeman |
First Address | Sewickley, PA 15143-9321 |
Second Address | Pittsburgh, PA 15212-4746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U06013 | (02) | PA |