Provider Demographics
NPI:1801081377
Name:20/20 OPTOMETRIC THOMAS CASAGRANDE, OD
Entity type:Organization
Organization Name:20/20 OPTOMETRIC THOMAS CASAGRANDE, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-221-8900
Mailing Address - Street 1:5110 N BLACKSTONE AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6708
Mailing Address - Country:US
Mailing Address - Phone:559-221-8900
Mailing Address - Fax:559-221-1831
Practice Address - Street 1:5110 N BLACKSTONE AVE
Practice Address - Street 2:STE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6708
Practice Address - Country:US
Practice Address - Phone:559-221-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CA0634670001Medicare NSC
CAZZZ29739ZMedicare PIN