Provider Demographics
NPI:1104893007
Name:FREEMAN, DAN E (OD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:E
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 1:803 MAIN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156
Mailing Address - Country:US
Mailing Address - Phone:620-221-2020
Mailing Address - Fax:620-221-7544
Practice Address - Street 1:803 MAIN
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156
Practice Address - Country:US
Practice Address - Phone:620-221-2020
Practice Address - Fax:620-221-7544
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090910BMedicaid
KS100090910BMedicaid
T43743Medicare UPIN