Provider Demographics
NPI:1013987213
Name:FRAZIER, RICHARD D JR (OD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:FRAZIER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5096 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4190
Mailing Address - Country:US
Mailing Address - Phone:810-733-6460
Mailing Address - Fax:810-733-5443
Practice Address - Street 1:5096 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4190
Practice Address - Country:US
Practice Address - Phone:810-733-6460
Practice Address - Fax:810-733-5443
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL4901002547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0775910001Medicare NSC