Provider Demographics
NPI:1417929456
Name:FRAZER, VALERIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:L
Last Name:FRAZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1021 QUINN DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2502
Mailing Address - Country:US
Mailing Address - Phone:608-849-4040
Mailing Address - Fax:608-849-4042
Practice Address - Street 1:1021 QUINN DR STE 400
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2502
Practice Address - Country:US
Practice Address - Phone:608-849-4040
Practice Address - Fax:608-849-4042
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2913-035152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38624200Medicaid
WI38624200Medicaid