Provider Demographics
NPI:1740350263
Name:FRIEDMAN, TERRY SETH
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:SETH
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 SW 72ND ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3245
Mailing Address - Country:US
Mailing Address - Phone:305-274-5070
Mailing Address - Fax:305-274-2621
Practice Address - Street 1:9350 SW 72ND ST
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3245
Practice Address - Country:US
Practice Address - Phone:305-274-5070
Practice Address - Fax:305-274-2621
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078417600Medicaid
FLT84186Medicare UPIN
FL19608Medicare PIN