Provider Demographics
NPI:1508017922
Name:FRASSATO, SARAH L (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:FRASSATO
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 1:249 AVENIDA DEL NORTE # 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5702
Mailing Address - Country:US
Mailing Address - Phone:310-540-6225
Mailing Address - Fax:310-540-2218
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:SUITE 101E
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-327-1561
Practice Address - Fax:760-327-4313
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010062152W00000X
CA15122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILRO3711OtherMEDICARE PROVIDER NUMBER
CACA135623Medicare PIN
ILRO3711OtherMEDICARE PROVIDER NUMBER
CACA135616Medicare PIN