Provider Demographics
NPI:1679565352
Name:FRACHT, STUART (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
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 1:2215 CALDER ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-1562
Mailing Address - Country:US
Mailing Address - Phone:409-835-5957
Mailing Address - Fax:409-835-5461
Practice Address - Street 1:2215 CALDER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-1562
Practice Address - Country:US
Practice Address - Phone:409-835-5957
Practice Address - Fax:409-835-5461
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2480TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13313Medicare UPIN
TX00E25EMedicare ID - Type Unspecified