Provider Demographics
NPI:1275782088
Name:DR. DAVID N LASSE OPTOMETRIST INC
Entity Type:Organization
Organization Name:DR. DAVID N LASSE OPTOMETRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:LASSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-631-8889
Mailing Address - Street 1:4600 SMITH RD
Mailing Address - Street 2:GRANDE CENTRAL STATION
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2793
Mailing Address - Country:US
Mailing Address - Phone:513-631-8889
Mailing Address - Fax:513-631-8891
Practice Address - Street 1:4600 SMITH RD
Practice Address - Street 2:GRANDE CENTRAL STATION
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2793
Practice Address - Country:US
Practice Address - Phone:513-631-8889
Practice Address - Fax:513-631-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232992Medicaid
OHT46594Medicare UPIN
OHDA4011181Medicare PIN