MEDICARE: DR. JOSEPH FRANK GRASSO 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	046006727	IL

General Provider Information

NPI Number	:	1003898768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH FRANK GRASSO O.D.

Provider Business Mailing Address
First Line	:	15 N LOCUST ST
Second Line	:
City	:	PINCKNEYVILLE
State	:	IL
Zip	:	62274-1147
Country	:	US
Telephone Number	:	618-357-6117
Fax Number	:	618-357-3406

Provider Business Practice Location Address
First Line	:	15 N LOCUST ST
Second Line	:
City	:	PINCKNEYVILLE
State	:	IL
Zip	:	62274-1147
Country	:	US
Telephone Number	:	618-357-6117
Fax Number	:	618-357-3406

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	02/22/2008

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