Healthcare Provider Details

I. General information

NPI: 1265619084
Provider Name (Legal Business Name): RICHARD D FRAZIER JR OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date: 12/22/2009
Reactivation Date: 02/07/2012

III. Provider practice location address

5096 CORUNNA RD
FLINT MI
48532-4190
US

IV. Provider business mailing address

5096 CORUNNA RD
FLINT MI
48532-4190
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-6460
  • Fax: 810-733-5443
Mailing address:
  • Phone: 810-733-6460
  • Fax: 810-733-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD DICKERSON FRAZIER JR.
Title or Position: OPTOMETRIST
Credential: OD
Phone: 810-733-6460