Provider Demographics
NPI:1720027873
Name:CASAMENTO, DAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:CASAMENTO
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 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2004
Mailing Address - Country:US
Mailing Address - Phone:814-368-7090
Mailing Address - Fax:814-368-5855
Practice Address - Street 1:20 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2004
Practice Address - Country:US
Practice Address - Phone:814-368-7090
Practice Address - Fax:814-368-5855
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist