Provider Demographics
NPI:1669463535
Name:CASSEY, CRAIG A (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:CASSEY
Suffix:
Gender:M
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0110498000OtherINDEPENDENCE BLUE CROSS
PA513325OtherHIGHMARK
PA55515OtherAETNA
PA513325OtherHIGHMARK
PA55515OtherAETNA