Provider Demographics
NPI:1598712127
Name:CRAIG A. CASSEY O D P C
Entity Type:Organization
Organization Name:CRAIG A. CASSEY O D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER OF OPTOMETRIC PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-872-6077
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-0008
Mailing Address - Country:US
Mailing Address - Phone:610-872-6077
Mailing Address - Fax:610-872-2845
Practice Address - Street 1:4590 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1728
Practice Address - Country:US
Practice Address - Phone:610-872-6077
Practice Address - Fax:610-872-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2151799000OtherINDEPENDENCE BLUE CROSS
PA4408014OtherAETNA
PA1467361OtherHIGHMARK
PA1467361OtherHIGHMARK