Provider Demographics
NPI:1326018458
Name:FRIEDLAND, PHILIP (LDO)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:FRIEDLAND
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7201
Mailing Address - Country:US
Mailing Address - Phone:706-543-7925
Mailing Address - Fax:706-546-9025
Practice Address - Street 1:3700 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7201
Practice Address - Country:US
Practice Address - Phone:706-543-7925
Practice Address - Fax:706-546-9025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001503156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician