Provider Demographics
NPI:1003071200
Name:MARK CASSOL MD PSC
Entity Type:Organization
Organization Name:MARK CASSOL MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-759-2765
Mailing Address - Street 1:PO BOX 8073
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257
Mailing Address - Country:US
Mailing Address - Phone:502-759-2765
Mailing Address - Fax:
Practice Address - Street 1:2600 W. BROADWAY, SUITE 105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211
Practice Address - Country:US
Practice Address - Phone:502-772-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty