NPIMap

Organization Active NPI

Douglas Fraser Vision Center

  • Optometrist
  • Wayne, MI
National Provider Identifier
1346407889
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901002413 Issued in MI
Legal business name
DOUGLAS FRASER VISION CENTER
Practice address
38110 Michigan Ave
Wayne, MI 48184-2842
Phone
(734) 728-5940
NPI assigned
May 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guy Flannery
Title
Chief Financial Officer
Phone
(248) 203-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4901002413 MI Primary

Addresses

Primary practice location

38110 Michigan Ave
Wayne, MI 48184-2842

Mailing address

38110 Michigan Ave
Wayne, MI 48184-2842
Phone (734) 728-5940

Other identifiers 1

IdentifierTypeStateIssuer
ON55750OtherMIMEDICARE PROVIDER #

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1346407889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38110 MICHIGAN AVE",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481842842",
            "telephone_number": "734-728-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38110 MICHIGAN AVE",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481842842",
            "telephone_number": "734-728-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS FRASER VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "FLANNERY",
        "authorized_official_first_name": "GUY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "248-203-1100"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "ON55750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.