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General NPI Number Information
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NPI Number | 1467763532
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Entity Type | Organization
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Legal Business Name | FRAZIER OPTICAL INC.
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 2531 E 5TH ST
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City | TYLER
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State | TX
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Zip | 75701-3544
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Country | US
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Telephone | 903-595-2946
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Fax | 903-595-3117
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Provider Business Mailing Address
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Address Line | 2351 E. FIFTH STREET
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City | TYLER
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State | TX
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Zip | 75701-3544
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Country | US
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Telephone | 903-595-2946
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Fax | 903-595-3117
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Authorized Official
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Title or Position | CERTIFIED OPTICIAN
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Name | MR. WILLIAM LEWIS FRAZIER
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Credential | ABOC
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Telephone | 903-595-2946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | DR 0728
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License Number State | TX
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