Ray A Lassen, OD
Individual provider Active NPI Optometrist · Doniphan, MO
NPI 1275523680 · NPPES record last updated Jun 29, 2010
Key facts
- NPI
- 1275523680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- T02728 (MO)
- Practice address
- 1 Oak Tree VLG
Ste 200
Doniphan, MO 63935-1901 - Phone
- (573) 996-7529
- Fax
- (573) 996-4162
- NPI assigned
- Oct 26, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1 Oak Tree Village
Suite 200
Doniphan, MO 63935-1901
1 Oak Tree VLG
Suite 200
Doniphan, MO 63935-1901
Phone (573) 996-7529
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101109000098 | MO | Practitioner - Optometry | 8426261652 | Practice locations: Doniphan, MO |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T02728 | MO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02728 | MO | Yes |
Addresses
Primary practice location
1 Oak Tree VLG
Ste 200
Doniphan, MO 63935-1901
Mailing address
1 Oak Tree VLG
Ste 200
Doniphan, MO 63935-1901
Phone (573) 996-7529
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 312537103 | Medicaid | MO | |
| 108471 | Other | MO | BLUE CROSS & BLUE SHIELD |
Other providers in Doniphan, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.