Provider Demographics
NPI:1770275893
Name:FRASER, EMMA SUNMI (OD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:SUNMI
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 1:647 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1503
Mailing Address - Country:US
Mailing Address - Phone:617-269-9465
Mailing Address - Fax:617-977-9999
Practice Address - Street 1:647 E BROADWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1503
Practice Address - Country:US
Practice Address - Phone:617-269-9465
Practice Address - Fax:617-977-9999
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist