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General NPI Number Information
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NPI Number | 1184731143
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Entity Type | Organization
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Legal Business Name | STANLEY E. LASSA, O.D., INC.
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 420 B. NORTH GRANT AVE.
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City | ODESSA
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State | TX
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Zip | 79761-9999
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Country | US
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Telephone | 432-332-9920
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Fax | 432-337-8833
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Provider Business Mailing Address
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Address Line | 420 B. NORTH GRANT AVE.
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City | ODESSA
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State | TX
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Zip | 79761-9999
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Country | US
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Telephone | 432-332-9920
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Fax | 432-337-8833
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE D. LASSA
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Credential | DR.OF OPTOMETRY
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Telephone | 432-332-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 03653TG
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License Number State | TX
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