Provider Demographics
NPI:1316942311
Name:FREGGER, MICHAEL ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:FREGGER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:17 RACETRACK RD NW
Mailing Address - Street 2:STE A
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-4607
Mailing Address - Country:US
Mailing Address - Phone:850-862-9595
Mailing Address - Fax:850-862-0099
Practice Address - Street 1:17 RACETRACK RD NW
Practice Address - Street 2:STE A
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-4607
Practice Address - Country:US
Practice Address - Phone:850-862-9595
Practice Address - Fax:850-862-0099
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC1985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19603Medicare PIN
FL0730770001Medicare NSC