Provider Demographics
NPI:1548200801
Name:CASSATA, ADRIENNE M (OD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:M
Last Name:CASSATA
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 1:2825 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2046
Mailing Address - Country:US
Mailing Address - Phone:716-564-2020
Mailing Address - Fax:716-564-2060
Practice Address - Street 1:2825 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2046
Practice Address - Country:US
Practice Address - Phone:716-564-2020
Practice Address - Fax:716-564-2060
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006812-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528608003OtherBLUE CROSS BLUE SHIELD OF WNY
NY000528608002OtherBLUE CROSS BLUE SHIELD OF WNY
NY02774716Medicaid
NYRB7337Medicare PIN
NY02774716Medicaid