Provider Demographics
NPI:1174688055
Name:FRATTO, ROZANNE M (OD)
Entity type:Individual
Prefix:
First Name:ROZANNE
Middle Name:M
Last Name:FRATTO
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 1:2036 SCALLY CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3000
Mailing Address - Country:US
Mailing Address - Phone:925-682-8602
Mailing Address - Fax:
Practice Address - Street 1:1350 TRAVIS BLVD # 1418A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3432
Practice Address - Country:US
Practice Address - Phone:707-423-9380
Practice Address - Fax:707-423-9393
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9979TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51060Medicare UPIN
CASD0099790Medicare ID - Type Unspecified