Provider Demographics
NPI:1003898768
Name:GRASSO, JOSEPH FRANK (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANK
Last Name:GRASSO
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 1:15 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1147
Mailing Address - Country:US
Mailing Address - Phone:618-357-6117
Mailing Address - Fax:618-357-3406
Practice Address - Street 1:15 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1147
Practice Address - Country:US
Practice Address - Phone:618-357-6117
Practice Address - Fax:618-357-3406
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006727152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
L72925Medicare PIN
410042046Medicare PIN
T38737Medicare UPIN
3979170001Medicare NSC
3979170003Medicare NSC
3979170004Medicare NSC
L86509Medicare PIN
410047520Medicare PIN
L72924Medicare PIN
410042197Medicare PIN
3979170005Medicare NSC
3979170002Medicare NSC
L86479Medicare PIN
410045370Medicare PIN
L86499Medicare PIN
410042198Medicare PIN