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General NPI Number Information
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NPI Number | 1710004106
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Entity Type | Individual
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Provider Name | KENT LEE FRAZIER OD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3200 LUSK DR
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City | NEOSHO
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State | MO
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Zip | 64850-2028
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Country | US
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Telephone | 417-451-1119
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Fax | 417-451-2479
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Provider Business Mailing Address
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Address Line | 604 SPLIT RAIL DR
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City | JOPLIN
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State | MO
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Zip | 64801-9198
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Country | US
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Telephone | 417-673-4066
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TO3105
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License Number State | MO
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