Provider Demographics
NPI:1114066933
Name:LASSMAN'S FINE EYEWEAR,INC.
Entity Type:Organization
Organization Name:LASSMAN'S FINE EYEWEAR,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:LASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:541-774-3937
Mailing Address - Street 1:530 CRATER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6810
Mailing Address - Country:US
Mailing Address - Phone:541-774-3937
Mailing Address - Fax:541-774-1937
Practice Address - Street 1:530 CRATER LAKE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6810
Practice Address - Country:US
Practice Address - Phone:541-774-3937
Practice Address - Fax:541-774-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090187156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty