Basic Information
Provider Information
NPI: 1376534958
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEDLAND
FirstName: ROBERT
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1510
Address2:  
City: EAU CLAIRE
State: WI
PostalCode: 547021510
CountryCode: US
TelephoneNumber: 6087850940
FaxNumber:  
Practice Location
Address1: 191 THEATER RD
Address2:  
City: ONALASKA
State: WI
PostalCode: 54650
CountryCode: US
TelephoneNumber: 6087850940
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/02/2005
LastUpdateDate: 09/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X27627WIY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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