Provider Demographics
NPI:1154338481
Name:WASSERMAN, FRANK (OD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FOUR SEASONS
Mailing Address - Street 2:#202
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 FOUR SEASONS
Practice Address - Street 2:#202
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:317-727-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02190152W00000X
FLOP1126152W00000X
GAOPT003490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT003490OtherGEORGIA OPTOMETRY LICENSE
FLOP1126OtherFLORIDA OPTOMETRY LICENSE
MO310753744Medicaid