Provider Demographics
NPI:1477592046
Name:FREEMAN, KERRY RONALD (OD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:RONALD
Last Name:FREEMAN
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 1:6162 GA HIGHWAY 21 S
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5507
Mailing Address - Country:US
Mailing Address - Phone:912-826-3949
Mailing Address - Fax:888-810-2083
Practice Address - Street 1:6162 GA HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5507
Practice Address - Country:US
Practice Address - Phone:912-826-3949
Practice Address - Fax:888-810-2083
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000788576BMedicaid
488752OtherBLUE CROSS BLUE SHIELD
488752OtherBLUE CROSS BLUE SHIELD
U69790Medicare UPIN
GA000788576BMedicaid