Provider Demographics
NPI:1205031978
Name:MICHAEL L FRIEDBERG OD PA
Entity Type:Organization
Organization Name:MICHAEL L FRIEDBERG OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRIEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-265-3937
Mailing Address - Street 1:15920 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2313
Mailing Address - Country:US
Mailing Address - Phone:281-265-3937
Mailing Address - Fax:281-494-3937
Practice Address - Street 1:15920 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2313
Practice Address - Country:US
Practice Address - Phone:281-265-3937
Practice Address - Fax:281-494-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2607TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00403WMedicare PIN