Provider Demographics
NPI:1265619175
Name:FREIDKIN, MARILYN BRENDA (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:BRENDA
Last Name:FREIDKIN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11819 PINEY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1414
Mailing Address - Country:US
Mailing Address - Phone:301-257-9252
Mailing Address - Fax:301-983-2487
Practice Address - Street 1:9812 FALLS RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3976
Practice Address - Country:US
Practice Address - Phone:301-299-6513
Practice Address - Fax:301-299-0419
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001153156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1101001153OtherLICENSE