Provider Demographics
NPI:1073758413
Name:FRIEDMAN, MICHELLE M (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MASHA
Other - Middle Name:M
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1577 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7201
Mailing Address - Country:US
Mailing Address - Phone:718-819-9560
Mailing Address - Fax:347-896-5559
Practice Address - Street 1:1577 E 18TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7201
Practice Address - Country:US
Practice Address - Phone:718-819-9560
Practice Address - Fax:347-896-5559
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist