Provider Demographics
NPI:1265481998
Name:FREEMAN, KATHLEEN FRASER (OD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FRASER
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:165 BACKBONE RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-9321
Mailing Address - Country:US
Mailing Address - Phone:412-749-2497
Mailing Address - Fax:412-749-2417
Practice Address - Street 1:420 E NORTH AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4746
Practice Address - Country:US
Practice Address - Phone:412-359-6300
Practice Address - Fax:412-359-6768
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-008157-P152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034674R1WMedicare ID - Type Unspecified
PAU06013Medicare UPIN