Provider Demographics
NPI:1891833778
Name:FRASER, NANCY (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 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:734-475-9063
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:734-475-9063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM24750Medicare ID - Type Unspecified