Provider Demographics
NPI:1699847087
Name:FRAZEE, LEWIS JACOB (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:JACOB
Last Name:FRAZEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4100 W 15TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5801
Mailing Address - Country:US
Mailing Address - Phone:972-867-7777
Mailing Address - Fax:972-519-1679
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:STE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5801
Practice Address - Country:US
Practice Address - Phone:972-867-7777
Practice Address - Fax:972-519-1679
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1289207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126155402Medicaid
TX126155402Medicaid
TX1322820001Medicare NSC
TX80H791Medicare PIN