Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 04465TG | TX |
NPI | 1003887670 |
---|---|
Provider Name | Bryan E Frazier |
First Address | Tyler, TX 75703-3905 |
Second Address | Tyler, TX 75703-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127245205 | (05) | TX |
U18737 | (02) | TX |