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General NPI Number Information
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NPI Number | 1114066933
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Entity Type | Organization
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Legal Business Name | LASSMAN'S FINE EYEWEAR,INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 530 CRATER LAKE AVE
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City | MEDFORD
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State | OR
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Zip | 97504-6810
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Country | US
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Telephone | 541-774-3937
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Fax | 541-774-1937
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Provider Business Mailing Address
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Address Line | 530 CRATER LAKE AVE
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City | MEDFORD
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State | OR
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Zip | 97504-6810
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Country | US
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Telephone | 541-774-3937
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Fax | 541-774-1937
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. CHRISTINA DIANE LASSMAN
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Credential | ABOC
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Telephone | 541-774-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 090187
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License Number State | OR
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