Provider Demographics
NPI:1093730178
Name:FREED-GILVEY, SUSAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:FREED-GILVEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:171 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2418
Mailing Address - Country:US
Mailing Address - Phone:908-852-6623
Mailing Address - Fax:908-852-2334
Practice Address - Street 1:171 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2418
Practice Address - Country:US
Practice Address - Phone:908-852-6623
Practice Address - Fax:908-852-2334
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00543000152W00000X
NJ27OA00543000152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7593503Medicaid
NJ223342537OtherTAX ID
NJ223342537OtherTAX ID
NJU75739Medicare UPIN