Provider Demographics
NPI:1609930791
Name:CASAK WOODHILL LLC
Entity Type:Organization
Organization Name:CASAK WOODHILL LLC
Other - Org Name:PAL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:AMBROSE
Authorized Official - Last Name:KLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-266-3003
Mailing Address - Street 1:1555 E NEW CIRCLE RD
Mailing Address - Street 2:SUITE #146
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1043
Mailing Address - Country:US
Mailing Address - Phone:859-266-3003
Mailing Address - Fax:859-266-9504
Practice Address - Street 1:1555 E NEW CIRCLE RD
Practice Address - Street 2:SUITE #146
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1043
Practice Address - Country:US
Practice Address - Phone:859-266-3003
Practice Address - Fax:859-266-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244184156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52800935Medicaid
4746990001Medicare ID - Type UnspecifiedMEDICARE ID#