Provider Demographics
NPI:1316022692
Name:FREELAND, MICHAEL BRIAN (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRIAN
Last Name:FREELAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 VERDUGO WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8632
Mailing Address - Country:US
Mailing Address - Phone:805-482-4628
Mailing Address - Fax:805-482-4620
Practice Address - Street 1:4976 VERDUGO WAY
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8632
Practice Address - Country:US
Practice Address - Phone:805-482-4628
Practice Address - Fax:805-482-4620
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10886T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0108860Medicaid
CAEF950ZOtherPTAN
CASD0108860Medicaid