Provider Demographics
NPI:1093870669
Name:FREEMAN, FELICIA S (OD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:S
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:SOROLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6842 LEBANON ROAD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7480
Mailing Address - Country:US
Mailing Address - Phone:972-712-7890
Mailing Address - Fax:972-712-3119
Practice Address - Street 1:6842 LEBANON ROAD
Practice Address - Street 2:SUITE #101
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7480
Practice Address - Country:US
Practice Address - Phone:972-712-7890
Practice Address - Fax:972-712-3119
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5075T152W00000X
TX5075TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU54319Medicare UPIN