Healthcare Provider Details

I. General information

NPI: 1447326244
Provider Name (Legal Business Name): FRASER OPTICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32925 GROESBECK HIGHWAY
FRASER MI
48026
US

IV. Provider business mailing address

32925 GROESBECK HIGHWAY
FRASER MI
48026
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-8888
  • Fax: 586-296-0726
Mailing address:
  • Phone: 586-293-8888
  • Fax: 586-296-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK ANDREW STEFANI
Title or Position: DOCTOR OWNER
Credential: DO
Phone: 586-293-8888