Provider Demographics
NPI:1679792451
Name:FRETLAND, VIVI SHAHIN (OD)
Entity Type:Individual
Prefix:DR
First Name:VIVI
Middle Name:SHAHIN
Last Name:FRETLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 E SILVER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7009
Mailing Address - Country:US
Mailing Address - Phone:352-732-6599
Mailing Address - Fax:800-611-5078
Practice Address - Street 1:2553 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7009
Practice Address - Country:US
Practice Address - Phone:352-732-6599
Practice Address - Fax:800-611-5078
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2508152W00000X
FLOP2562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU25748Medicare UPIN