Healthcare Provider Details

I. General information

NPI: 1235190208
Provider Name (Legal Business Name): LASSA J FRANK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SIR FRANCIS DRAKE BLVD
SAN ANSELMO CA
94960-1845
US

IV. Provider business mailing address

1604 SIR FRANCIS DRAKE BLVD
SAN ANSELMO CA
94960-1845
US

V. Phone/Fax

Practice location:
  • Phone: 415-453-8906
  • Fax: 415-453-0156
Mailing address:
  • Phone: 415-453-8906
  • Fax: 415-453-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8464TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: