Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician |
NPI | 1164413126 |
---|---|
Provider Name | Scott Garth Freeman |
First Address | Fogelsville, PA 18051-2046 |
Second Address | Fogelsville, PA 18051-2046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 08/07/2007 |