Provider Demographics
NPI:1538352562
Name:FREEMAN, TERRY DALE (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DALE
Last Name:FREEMAN
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 1:519 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1043
Mailing Address - Country:US
Mailing Address - Phone:304-752-5659
Mailing Address - Fax:304-752-6329
Practice Address - Street 1:519 2ND ST W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1043
Practice Address - Country:US
Practice Address - Phone:304-752-5659
Practice Address - Fax:304-752-6329
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1003-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist