Provider Demographics
NPI:1760577720
Name:GRASSO, ROBERT J (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:GRASSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3104
Mailing Address - Country:US
Mailing Address - Phone:631-589-5544
Mailing Address - Fax:631-218-0919
Practice Address - Street 1:22 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3104
Practice Address - Country:US
Practice Address - Phone:631-589-5544
Practice Address - Fax:631-218-0919
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC50091Medicare PIN
NY18020Medicare UPIN