Provider Demographics
NPI:1134685084
Name:DR. CASSATA EYE CARE OPTOMETRIST, P.C.
Entity Type:Organization
Organization Name:DR. CASSATA EYE CARE OPTOMETRIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSATA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-909-9763
Mailing Address - Street 1:P.O. BOX 847
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072
Mailing Address - Country:US
Mailing Address - Phone:716-909-9763
Mailing Address - Fax:
Practice Address - Street 1:1780 GRAND ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072
Practice Address - Country:US
Practice Address - Phone:716-909-9763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02774716Medicaid
NYNY6812OtherEYE MED PROVIDER NO.