Healthcare Provider Details

I. General information

NPI: 1437134509
Provider Name (Legal Business Name): MICHEL-ANN ELIZABETH FRASER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MICHEL-ANN ELIZABETH FRASER JAMES

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2350
  • Fax:
Mailing address:
  • Phone: 608-324-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2737035
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: