Provider Demographics
NPI:1881741213
Name:FREED, AMY JEAN (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:FREED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 HALLGREN CT
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-7755
Mailing Address - Country:US
Mailing Address - Phone:612-554-0770
Mailing Address - Fax:
Practice Address - Street 1:1464 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2525
Practice Address - Country:US
Practice Address - Phone:952-466-3937
Practice Address - Fax:952-466-3936
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU68764Medicare UPIN
MN410002348Medicare PIN