Provider Demographics
NPI:1497745871
Name:FRIEDMAN, STEVEN DAVID (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:FRIEDMAN
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 1:19900 W CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4032
Mailing Address - Country:US
Mailing Address - Phone:704-892-8282
Mailing Address - Fax:704-973-0028
Practice Address - Street 1:19900 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4032
Practice Address - Country:US
Practice Address - Phone:704-892-8282
Practice Address - Fax:704-973-0028
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0979152W00000X
NC979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919276Medicaid
NCT64823Medicare UPIN
NC246276BMedicare PIN