Provider Demographics
NPI:1023163185
Name:FRASER, MICHELLE RENE
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENE
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLEAR EYES RX
Mailing Address - Street 2:494 STATE ROUTE 17 NORTH
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3012
Mailing Address - Country:US
Mailing Address - Phone:201-599-1102
Mailing Address - Fax:201-599-1202
Practice Address - Street 1:494 STATE ROUTE 17 NORTH
Practice Address - Street 2:CLEAR EYES RX
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3012
Practice Address - Country:US
Practice Address - Phone:201-599-1102
Practice Address - Fax:201-599-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00552800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist