Healthcare Provider Details

I. General information

NPI: 1982960647
Provider Name (Legal Business Name): WILLIAM CHALMER FRAZIER OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 COMMERCIAL DR
VANCEBURG KY
41179-6181
US

IV. Provider business mailing address

185 COMMERCIAL DR
VANCEBURG KY
41179-6181
US

V. Phone/Fax

Practice location:
  • Phone: 606-923-5997
  • Fax: 606-796-9285
Mailing address:
  • Phone: 606-923-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number605
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: