Provider Demographics
NPI:1821789058
Name:FREGEAU, LINDA KAY
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:FREGEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17961 S US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8685
Mailing Address - Country:US
Mailing Address - Phone:352-307-4435
Mailing Address - Fax:352-307-4437
Practice Address - Street 1:17961 S US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8685
Practice Address - Country:US
Practice Address - Phone:352-307-4435
Practice Address - Fax:352-307-4437
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7271156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician