Provider Demographics
NPI:1790999134
Name:LOVELL, FREDDIE (BOARD CERTIFIED)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:
Last Name:LOVELL
Suffix:
Gender:M
Credentials:BOARD CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3100
Mailing Address - Country:US
Mailing Address - Phone:954-587-7075
Mailing Address - Fax:954-587-7076
Practice Address - Street 1:133 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3100
Practice Address - Country:US
Practice Address - Phone:954-587-7075
Practice Address - Fax:954-587-7076
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 3084156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630184300Medicaid