Organization
DOUGLAS FRASER VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY FLANNERY (CHIEF FINANCIAL OFFICER)
(248) 203-1100
Entity
Organization
Contact information
Practice address
38110 MICHIGAN AVE, WAYNE, MI 48184-2842
(734) 728-5940
Mailing address
38110 MICHIGAN AVE, WAYNE, MI 48184-2842
(734) 728-5940
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002413
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ON55750
MEDICARE PROVIDER #
MI
Enumeration date
05/21/2008
Last updated
05/21/2008
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