Provider Demographics
NPI:1417025594
Name:FREE, DAVID RANDAL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDAL
Last Name:FREE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1223 S PEORIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5004
Mailing Address - Country:US
Mailing Address - Phone:918-582-7346
Mailing Address - Fax:918-585-3331
Practice Address - Street 1:1223 S PEORIA AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5004
Practice Address - Country:US
Practice Address - Phone:918-582-7346
Practice Address - Fax:918-585-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U50125Medicare UPIN