Benjamin Russell Fraysur Valid NPI

Individual provider · Optometrist · Hattiesburg, MS

NPI

1629833298

Type

Individual (Type 1)

Primary specialty

Optometrist

Specialty group

Eye and Vision Services Providers

Taxonomy code

152W00000X

License number

1099 (MS)

Sex

Male

Sole proprietor

Yes

Enumerated

2024-02-14

Last updated

2024-08-05