Provider Demographics
NPI:1962497644
Name:FRIEDMAN, MAX IRVING (OD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:IRVING
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 LOCKWOOD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2902
Mailing Address - Country:US
Mailing Address - Phone:941-355-6900
Mailing Address - Fax:941-359-1969
Practice Address - Street 1:8320 LOCKWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2902
Practice Address - Country:US
Practice Address - Phone:941-355-6900
Practice Address - Fax:941-359-1969
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02569TG152W00000X
FL0PC1433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN345Medicare PIN
TXT13339Medicare UPIN