Basic Information
| Provider Information | |||||||||
| NPI: | 1306840111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TASSI | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053363230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2501 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053363230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 09/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1655 | IA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 649 | SD | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | T03000 | MO | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 1131 | NE | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 298638800 | 05 | MN | MEDICAID | 5119065 | 05 | IA | MEDICAID | 10025032100 | 05 | NE | MEDICAID | 46044447400 | 05 | NE | MEDICAID | 9200750 | 05 | SD | MEDICAID | 9200754 | 05 | SD | MEDICAID | 9200752 | 05 | SD | MEDICAID | 9200753 | 05 | SD | MEDICAID | 3119065 | 05 | IA | MEDICAID |