MEDICARE: LEWIS JACOB FRAZEE MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G1289	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275606329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS JACOB FRAZEE MD PA

Provider Business Mailing Address
First Line	:	4100 W 15TH ST
Second Line	:	SUITE 210
City	:	PLANO
State	:	TX
Zip	:	75093-5801
Country	:	US
Telephone Number	:	972-867-7777
Fax Number	:	972-519-1679

Provider Business Practice Location Address
First Line	:	4100 W 15TH ST
Second Line	:	SUITE 210
City	:	PLANO
State	:	TX
Zip	:	75093-5801
Country	:	US
Telephone Number	:	972-867-7777
Fax Number	:	972-519-1679

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MRS. SKYE JOHNSON
Credential	:
Telephone Number	:	972-867-7777

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	04/09/2025

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