Provider Demographics
NPI:1437134509
Name:FRASER, MICHEL-ANN ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:MICHEL-ANN
Middle Name:ELIZABETH
Last Name:FRASER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MICHEL-ANN
Other - Middle Name:ELIZABETH
Other - Last Name:FRASER JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2350
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2737035152W00000X
IL046008965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008965Medicaid
IL305970Medicare ID - Type Unspecified
IL046008965Medicaid