Provider Demographics
NPI:1215181748
Name:NATHAN FREED OD, PA
Entity Type:Organization
Organization Name:NATHAN FREED OD, PA
Other - Org Name:FREED VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-864-2965
Mailing Address - Street 1:1301 PATERSON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3707
Mailing Address - Country:US
Mailing Address - Phone:201-864-2965
Mailing Address - Fax:
Practice Address - Street 1:1301 PATERSON PLANK RD
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3707
Practice Address - Country:US
Practice Address - Phone:201-864-2965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA005236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0672408Medicare PIN