Provider Demographics
NPI:1699793067
Name:FREEMAN, REX H III (OD)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:H
Last Name:FREEMAN
Suffix:III
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 1:1575 HWY 66 SOUTH
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-993-6880
Mailing Address - Fax:336-993-6950
Practice Address - Street 1:1575 HWY. 66 SO.
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-993-6880
Practice Address - Fax:336-993-6950
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909295Medicaid
NC8909295Medicaid
NCT64956Medicare UPIN