Provider Demographics
NPI:1679846521
Name:MEDICAL EYE ASSOCIATES OF LOUISVILLE PSC
Entity Type:Organization
Organization Name:MEDICAL EYE ASSOCIATES OF LOUISVILLE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-759-2765
Mailing Address - Street 1:7840 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4301
Mailing Address - Country:US
Mailing Address - Phone:513-354-5808
Mailing Address - Fax:
Practice Address - Street 1:3999 DUTCHMANS LN
Practice Address - Street 2:SUITE 5F
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4729
Practice Address - Country:US
Practice Address - Phone:502-899-2179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023128063Medicare Oscar/Certification