Provider Demographics
NPI:1407049216
Name:NANCY FRASER OD
Entity Type:Organization
Organization Name:NANCY FRASER OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-475-9953
Mailing Address - Street 1:1200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1423
Mailing Address - Country:US
Mailing Address - Phone:734-475-9953
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1423
Practice Address - Country:US
Practice Address - Phone:734-475-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002854332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM24750Medicare PIN
MI1121710001Medicare NSC