Provider Demographics
NPI:1073167151
Name:LASSLEY, REBECCA (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LASSLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 MAHAN DR.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-216-2020
Mailing Address - Fax:850-671-3239
Practice Address - Street 1:2858 MAHAN DR.
Practice Address - Street 2:SUITE 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-216-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOPC5718152W00000X
FL5718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist