MEDICARE: DR. LASSA J FRANK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8464TPL	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00260245	OTHER	CA	MEDICARE RAILROAD PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5091080001	OTHER	CA	DMERC CIGNA SUPPLIER #
2	680226455	OTHER	CA	VISION SERVICE PLAN ID#
3	8464TPL	OTHER	CA	LICENSE NUMBER
5	0003748569	OTHER	CA	CALIFORNIA EMPLOYER ID
6	680226455	OTHER	CA	BLUE CROSS ID NUMBER
7	680226455	OTHER	CA	UNITEDHEALTHCARE ID #
8	942846602	OTHER	CA	FEDERAL ID NUMBER
9	SD0084640	OTHER	CA	BLUE SHIELD PIN

General Provider Information

NPI Number	:	1235190208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LASSA J FRANK O.D.

Provider Business Mailing Address
First Line	:	1604 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1845
Country	:	US
Telephone Number	:	415-453-8906
Fax Number	:	415-453-0156

Provider Business Practice Location Address
First Line	:	1604 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1845
Country	:	US
Telephone Number	:	415-453-8906
Fax Number	:	415-453-0156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. LASSA J FRANK O.D.” Practice Location

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