=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275799918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARP OPTICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2008
-----------------------------------------------------
Last Update Date | 08/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 N PLANO RD # 100
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-530-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1410 NORTH PLANO #100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-530-8800
-----------------------------------------------------
Fax | 972-761-0388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID ROBERT FRAZEE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 972-530-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 2606TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------