Provider Demographics
NPI:1649413253
Name:FREELAND EYE ASSOCIATES
Entity type:Organization
Organization Name:FREELAND EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROP
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANZELMI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-636-0355
Mailing Address - Street 1:509 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-1901
Mailing Address - Country:US
Mailing Address - Phone:570-636-0355
Mailing Address - Fax:570-636-3285
Practice Address - Street 1:509 CENTRE ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:PA
Practice Address - Zip Code:18224-1901
Practice Address - Country:US
Practice Address - Phone:570-636-0355
Practice Address - Fax:570-636-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000326332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1182960001Medicare NSC