Provider Demographics
NPI:1265184865
Name:FREEDOM OPTICAL INCORPORATED
Entity type:Organization
Organization Name:FREEDOM OPTICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:HART SIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:321-305-6647
Mailing Address - Street 1:4725 FAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8284
Mailing Address - Country:US
Mailing Address - Phone:321-305-6647
Mailing Address - Fax:321-208-8019
Practice Address - Street 1:4725 FAY BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-8284
Practice Address - Country:US
Practice Address - Phone:321-305-6647
Practice Address - Fax:321-208-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier