Provider Demographics
NPI:1346305232
Name:FREEBERG, DALE D (OD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:FREEBERG
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 1:1421 CRAVENS AVE
Mailing Address - Street 2:#322
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2730
Mailing Address - Country:US
Mailing Address - Phone:310-328-3030
Mailing Address - Fax:310-328-4141
Practice Address - Street 1:616 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3206
Practice Address - Country:US
Practice Address - Phone:626-303-5125
Practice Address - Fax:626-358-7448
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT69739Medicare UPIN
CAWOP3322Medicare ID - Type Unspecified