Provider Demographics
NPI:1497831846
Name:FRIEDMAN, STUART ADDIS (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:ADDIS
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 1:132 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3521
Mailing Address - Country:US
Mailing Address - Phone:718-852-1149
Mailing Address - Fax:718-522-4379
Practice Address - Street 1:132 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3521
Practice Address - Country:US
Practice Address - Phone:718-852-1149
Practice Address - Fax:718-522-4379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400060548Medicare PIN
NYT81491Medicare UPIN
NYC30431Medicare PIN