Provider Demographics
NPI:1497255236
Name:CASSIE MARK LLC
Entity Type:Organization
Organization Name:CASSIE MARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-431-5747
Mailing Address - Street 1:42 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1918
Mailing Address - Country:US
Mailing Address - Phone:617-431-5747
Mailing Address - Fax:
Practice Address - Street 1:42 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1918
Practice Address - Country:US
Practice Address - Phone:617-869-8464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty