Provider Demographics
NPI:1518035443
Name:NASSAR, JOANNE L (OD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:NASSAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 VALLEY SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0905
Mailing Address - Country:US
Mailing Address - Phone:725-225-5161
Mailing Address - Fax:
Practice Address - Street 1:6363 VALLEY SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0905
Practice Address - Country:US
Practice Address - Phone:725-225-5161
Practice Address - Fax:702-319-2156
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV433152W00000X
CA10941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist