Provider Demographics
NPI:1679770747
Name:FREEHOLD FAMILY EYEWEAR, INC.
Entity type:Organization
Organization Name:FREEHOLD FAMILY EYEWEAR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:732-247-1970
Mailing Address - Street 1:232 RYDERS LN
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1353
Mailing Address - Country:US
Mailing Address - Phone:732-247-1970
Mailing Address - Fax:
Practice Address - Street 1:232 RYDERS LN
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1353
Practice Address - Country:US
Practice Address - Phone:732-247-1970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0K9659OtherHEALTHNET
NJ0K9659OtherHEALTHNET