Provider Demographics
NPI:1609036797
Name:DALE SHEEN
Entity Type:Organization
Organization Name:DALE SHEEN
Other - Org Name:FREEDOM ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:SL
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:CO, LPO
Authorized Official - Phone:281-580-8228
Mailing Address - Street 1:PO BOX 90939
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0939
Mailing Address - Country:US
Mailing Address - Phone:281-580-8228
Mailing Address - Fax:281-580-8229
Practice Address - Street 1:3185 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1410
Practice Address - Country:US
Practice Address - Phone:409-839-8888
Practice Address - Fax:409-839-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X, 332B00000X
TX1335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6107890001Medicare NSC