Provider Demographics
NPI:1598824914
Name:DAVID R. FREE, O.D. PC
Entity Type:Organization
Organization Name:DAVID R. FREE, O.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-582-7346
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2776900001OtherCIGNA
OKOK1176OtherEYEMED
OK445747074002-BCBSOtherBCBS
OK5022187OtherAETNA
OK=========OtherPRIMARY VISION CARE SERV
OK=========OtherVISION SERVICE PLAN
OK=========OtherCOMMUNITY CARE SR
OKOK1176OtherEYEMED
OK=========OtherCOMMUNITY CARE HMO
OK=========OtherFIRST HEALTH
OK=========OtherPREFERRED COMMUNITY CHOIC
OK5022187OtherAETNA
OK=========OtherUNITED HEALTHCARE
OKOK1176OtherEYEMED
OK=========OtherVISION SERVICE PLAN