Provider Demographics
NPI:1609971217
Name:FRAGIN, GERALD (OD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:FRAGIN
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 1:341 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2439
Mailing Address - Country:US
Mailing Address - Phone:570-347-5400
Mailing Address - Fax:570-342-0221
Practice Address - Street 1:341 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2439
Practice Address - Country:US
Practice Address - Phone:570-347-5400
Practice Address - Fax:570-342-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA4442P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist