Provider Demographics
NPI:1003887670
Name:FRAZIER, BRYAN E (OD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:E
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5791 NEW COPELAND RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3905
Mailing Address - Country:US
Mailing Address - Phone:903-339-3035
Mailing Address - Fax:903-339-3036
Practice Address - Street 1:5791 NEW COPELAND RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3905
Practice Address - Country:US
Practice Address - Phone:903-339-3035
Practice Address - Fax:903-339-3036
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04465TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127245205Medicaid
TX127245205Medicaid
TX00E77UMedicare PIN
TX85Z609Medicare PIN