Provider Demographics
NPI:1093145211
Name:BAZAN, FRANK ANDRES (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANDRES
Last Name:BAZAN
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 1:6101 LOUISVILLE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8330
Mailing Address - Country:US
Mailing Address - Phone:214-236-4685
Mailing Address - Fax:
Practice Address - Street 1:1200 E SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3023
Practice Address - Country:US
Practice Address - Phone:972-422-1047
Practice Address - Fax:972-423-9616
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 03913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist