Provider Demographics
NPI:1558539726
Name:G & L CASSEL LTD.
Entity Type:Organization
Organization Name:G & L CASSEL LTD.
Other - Org Name:L&S OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-828-9270
Mailing Address - Street 1:8415 BELLONA LANE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2015
Mailing Address - Country:US
Mailing Address - Phone:410-828-9270
Mailing Address - Fax:410-321-0124
Practice Address - Street 1:8415 BELLONA LANE
Practice Address - Street 2:SUITE 104
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2015
Practice Address - Country:US
Practice Address - Phone:410-828-9270
Practice Address - Fax:410-321-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MD06755568332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0825070001Medicare NSC