Provider Demographics
NPI:1629108600
Name:CASAGRANDE, THOMAS RALPH (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RALPH
Last Name:CASAGRANDE
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 1:5110 N. BLACKSTONE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6708
Mailing Address - Country:US
Mailing Address - Phone:559-221-8900
Mailing Address - Fax:559-221-1831
Practice Address - Street 1:5110 N BLACKSTONE AVE STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6708
Practice Address - Country:US
Practice Address - Phone:559-221-8900
Practice Address - Fax:559-221-1831
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7751T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7751TOtherLICENSE
CA810637142OtherTAX ID
CA810637142OtherTAX ID
CAT10591Medicare UPIN
CA0634670001Medicare NSC