Provider Demographics
NPI:1114066081
Name:FRACHT, CAREY R (OD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:R
Last Name:FRACHT
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 1:130 N AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4102
Mailing Address - Country:US
Mailing Address - Phone:409-384-5192
Mailing Address - Fax:
Practice Address - Street 1:130 N AUSTIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4102
Practice Address - Country:US
Practice Address - Phone:409-384-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2833T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0199080001OtherBLUE CROSS BLUE SHIELD
TXT13314OtherNOT CERTAIN
TX0199080001OtherBLUE CROSS BLUE SHIELD
TX0199080001OtherBLUE CROSS BLUE SHIELD
TXT13314OtherNOT CERTAIN