Provider Demographics
NPI:1427057124
Name:LASSE, DAVID NOEL (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NOEL
Last Name:LASSE
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 1:4600 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2793
Mailing Address - Country:US
Mailing Address - Phone:513-631-8889
Mailing Address - Fax:513-631-8891
Practice Address - Street 1:4600 SMITH RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2793
Practice Address - Country:US
Practice Address - Phone:513-631-8889
Practice Address - Fax:513-631-8891
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232993Medicaid
OH0536330001Medicare NSC
OH0232993Medicaid
OH4011182Medicare PIN
OH4011181Medicare PIN