Provider Demographics
NPI:1811911365
Name:FREEH, TIMOTHY RAY (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAY
Last Name:FREEH
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 1:831 LANCASTER DR
Mailing Address - Street 2:STE #151
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-364-4896
Mailing Address - Fax:503-589-1503
Practice Address - Street 1:831 LANCASTER DR
Practice Address - Street 2:STE #151
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-364-4896
Practice Address - Fax:503-589-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1834T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist