Provider Demographics
NPI:1932331477
Name:W FRASER VIPOND M.D.,P.C.
Entity Type:Organization
Organization Name:W FRASER VIPOND M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W.
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:VIPOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-774-2626
Mailing Address - Street 1:20919 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2825
Mailing Address - Country:US
Mailing Address - Phone:586-774-2626
Mailing Address - Fax:586-774-2340
Practice Address - Street 1:20919 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-774-2626
Practice Address - Fax:586-774-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5001100001Medicare NSC
MIB44966Medicare UPIN
MI0509058Medicare PIN