Provider Demographics
NPI:1043994106
Name:CASEY, BROOKE (LDO)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 TIMPANY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3452
Mailing Address - Country:US
Mailing Address - Phone:978-894-5251
Mailing Address - Fax:978-632-1962
Practice Address - Street 1:677 TIMPANY BLVD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-669-4094
Practice Address - Fax:978-632-1962
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6628156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician