Basic Information
| Provider Information | |||||||||
| NPI: | 1073257077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | MACY | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8614 WESTWOOD CENTER DR FL 19 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221822442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 5712236780 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 LAWRENCEVILLE SUWANEE RD STE 560 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300438481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709630370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2022 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT003427 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.