Provider Demographics
NPI:1760516744
Name:KASIK, ROBERT H (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:KASIK
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 1:1381 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7602
Mailing Address - Country:US
Mailing Address - Phone:770-971-6155
Mailing Address - Fax:
Practice Address - Street 1:4101 ROSWELL RD
Practice Address - Street 2:SUITE 905
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6293
Practice Address - Country:US
Practice Address - Phone:770-565-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU18689Medicare UPIN
GA41ZCBPDMedicare ID - Type Unspecified