Provider Demographics
NPI:1538279393
Name:ERIC G FRIEDMAN MD PC
Entity Type:Organization
Organization Name:ERIC G FRIEDMAN MD PC
Other - Org Name:VALPARAISO EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-3937
Mailing Address - Street 1:552 W LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-5531
Mailing Address - Country:US
Mailing Address - Phone:219-464-3937
Mailing Address - Fax:219-462-1534
Practice Address - Street 1:552 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-5531
Practice Address - Country:US
Practice Address - Phone:219-464-3937
Practice Address - Fax:219-462-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028202207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000102346OtherANTHEM
IN100208400AMedicaid
D69788Medicare UPIN
IN0344540001Medicare NSC
000000102346OtherANTHEM