Provider Demographics
NPI:1306831037
Name:FREEDMAN, LYLE ERIC (MD)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:ERIC
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6426
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0426
Mailing Address - Country:US
Mailing Address - Phone:817-551-5600
Mailing Address - Fax:
Practice Address - Street 1:11803 S FREEWAY
Practice Address - Street 2:STE 114
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-551-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDG2369207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C15746Medicare UPIN
TX00SC63Medicare PIN