Provider Demographics
NPI:1770696304
Name:LYLE FREEDMAN MD HUGULEY OPTICAL
Entity type:Organization
Organization Name:LYLE FREEDMAN MD HUGULEY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-551-5600
Mailing Address - Street 1:PO BOX 6426
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0426
Mailing Address - Country:US
Mailing Address - Phone:817-551-5600
Mailing Address - Fax:
Practice Address - Street 1:11803 S FREEWAY
Practice Address - Street 2:STE 114-116
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-0426
Practice Address - Country:US
Practice Address - Phone:817-551-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYLE E. FREEDMAN, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDG2369156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0566600001Medicare NSC