Provider Demographics
NPI:1841490406
Name:DALESSANDRO, TODD MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:DALESSANDRO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1460 TOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2407
Mailing Address - Country:US
Mailing Address - Phone:330-392-0311
Mailing Address - Fax:330-392-0323
Practice Address - Street 1:77 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1615
Practice Address - Country:US
Practice Address - Phone:440-352-0616
Practice Address - Fax:440-352-0618
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5710152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2903184Medicaid
OH4225163Medicare PIN