Provider Demographics
NPI:1881659001
Name:SASSAMAN, ANDREW E (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:SASSAMAN
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 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:1830 STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7301
Practice Address - Country:US
Practice Address - Phone:563-382-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02177152W00000X
MN3132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19525OtherGROUP BCBS
IA0212225Medicaid
IA19525OtherGROUP
IA22032OtherBCBS
IA0195255Medicaid
IA19525OtherGROUP BCBS
MN410002989Medicare PIN
MN410002989Medicare PIN