Provider Demographics
NPI:1194270561
Name:FRASHER, JACK LESTER (OD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:LESTER
Last Name:FRASHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2818
Mailing Address - Country:US
Mailing Address - Phone:864-979-0983
Mailing Address - Fax:864-235-3068
Practice Address - Street 1:401 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2818
Practice Address - Country:US
Practice Address - Phone:864-979-0983
Practice Address - Fax:864-235-3068
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$OtherSOCIAL SECURITY NUMBER