Provider Demographics
NPI:1265619084
Name:RICHARD D FRAZIER JR OD
Entity type:Organization
Organization Name:RICHARD D FRAZIER JR OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DICKERSON
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:810-733-6460
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2013-03-27
Deactivation Date:2009-12-22
Deactivation Code:
Reactivation Date:2012-02-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0775910001Medicare NSC