Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT-0022511 | AZ |
NPI | 1003227059 |
---|---|
Provider Name | Kelly Noel Freese |
First Address | Chandler, AZ 85226-2654 |
Second Address | Sartell, MN 56377-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 08/01/2021 |