Provider Demographics
NPI:1366431942
Name:LASS, JONATHAN H (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:LASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043240207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000512667OtherANTHEM
OH363739OtherWELLCARE
OH0398270OtherBCMH
OH0398270Medicaid
OH734684OtherBUCKEYE
OHP00398029OtherRAILROAD MEDICARE
OH660752OtherAETNA
OH000000221072OtherUNISON
OH000000512667OtherANTHEM
OH734684OtherBUCKEYE
OH0398270OtherBCMH