MEDICARE: LASSA J. FRANK, OD, INC

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

General Provider Information

NPI Number	:	1356759377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASSA J. FRANK, OD, INC

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	:	OWNER
Name	:	DR. LASSA J FRANK
Credential	:	OD
Telephone Number	:	415-453-8906

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/23/2014

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