Provider Demographics
NPI:1184731143
Name:STANLEY E. LASSA, O.D., INC.
Entity type:Organization
Organization Name:STANLEY E. LASSA, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DROF OPTOMETRY
Authorized Official - Phone:432-332-9920
Mailing Address - Street 1:420 B. NORTH GRANT AVE.
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-9999
Mailing Address - Country:US
Mailing Address - Phone:432-332-9920
Mailing Address - Fax:432-337-8833
Practice Address - Street 1:420 B. NORTH GRANT AVE.
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-9999
Practice Address - Country:US
Practice Address - Phone:432-332-9920
Practice Address - Fax:432-337-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03653TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019469801Medicaid
0598680001Medicare NSC
00E71GMedicare PIN
T92020Medicare UPIN