Healthcare Provider Details

I. General information

NPI: 1144211525
Provider Name (Legal Business Name): FRACER OPTICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32925 GROESBECK HWY
FRASER MI
48026-3155
US

IV. Provider business mailing address

32925 GROESBECK HWY
FRASER MI
48026-3155
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-8888
  • Fax: 586-293-8940
Mailing address:
  • Phone: 586-293-8888
  • Fax: 586-293-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003690
License Number StateMI

VIII. Authorized Official

Name: MARK A STEFANI
Title or Position: OWNER.OPTOMETRIST
Credential: OD
Phone: 586-293-8888