Provider Demographics
NPI:1851364921
Name:FRIEDMAN, TRACI ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACI
Middle Name:ANN
Last Name:FRIEDMAN
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 1:905 W. BRIDGE ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226
Mailing Address - Country:US
Mailing Address - Phone:515-329-6454
Mailing Address - Fax:515-984-3436
Practice Address - Street 1:905 W. BRIDGE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226
Practice Address - Country:US
Practice Address - Phone:515-329-6454
Practice Address - Fax:515-984-3436
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47414Medicare ID - Type Unspecified
IAU72904Medicare UPIN