Provider Demographics
NPI:1730138801
Name:CASSANO, MICHAEL JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:CASSANO
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 1:2239 KENYON CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-1392
Mailing Address - Country:US
Mailing Address - Phone:630-701-2441
Mailing Address - Fax:
Practice Address - Street 1:608 S WASHINGTON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6663
Practice Address - Country:US
Practice Address - Phone:630-718-1031
Practice Address - Fax:630-718-1039
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008556152W00000X
IL346.000642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV10950Medicare UPIN