Provider Demographics
NPI:1376110346
Name:LOGRASSO, LORENZO (OD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:LOGRASSO
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 1:47695 ROBINS NEST DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5200
Mailing Address - Country:US
Mailing Address - Phone:586-480-9044
Mailing Address - Fax:
Practice Address - Street 1:33100 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-4036
Practice Address - Country:US
Practice Address - Phone:586-294-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist