Provider Demographics
NPI:1720056880
Name:ASATO, THERESA T (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:T
Last Name:ASATO
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 1:1031 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2746
Mailing Address - Country:US
Mailing Address - Phone:530-527-2211
Mailing Address - Fax:530-527-7412
Practice Address - Street 1:1031 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2746
Practice Address - Country:US
Practice Address - Phone:530-527-2211
Practice Address - Fax:530-527-7412
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1304560002OtherMEDICARE NSC
CA0081890Medicaid
CA0081890Medicaid
U63174Medicare UPIN
CASD0081890Medicare PIN
CA1340560001Medicare NSC
CA410033635Medicare PIN