Active NPI
Charles L Friedman, MD
- Ophthalmology Physician
- Collinsville, IL
National Provider Identifier
1962410738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Practice address
- 415 West Main Street
Ste 7
Collinsville, IL 62234-3043 - Phone
- (618) 344-7866
- Fax
- (618) 345-0503
- NPI assigned
- Aug 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | IL | Primary |
Addresses
Primary practice location
415 West Main Street
Ste 7
Collinsville, IL 62234-3043
Mailing address
321 North Central Avenue
St Louis, MO 63105
Phone (314) 727-1297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036052262 | IL | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Retina Surgery LTD | Past | Accepting new patients | |
| JFJ Eyecare LTD | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Ophthalmic Technician/Technologist
- Swansea, IL
- NPI 1255374559
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962410738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 NORTH CENTRAL AVENUE",
"city": "ST LOUIS",
"state": "MO",
"postal_code": "63105",
"telephone_number": "314-727-1297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 WEST MAIN STREET",
"address_2": "STE 7",
"city": "COLLINSVILLE",
"state": "IL",
"postal_code": "622343043",
"telephone_number": "618-344-7866",
"fax_number": "618-345-0503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRIEDMAN",
"first_name": "CHARLES",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collinsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.