Provider Demographics
NPI:1821035759
Name:CASSEYS OPTICAL, INC
Entity Type:Organization
Organization Name:CASSEYS OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:CASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:ABO CERTIFIED
Authorized Official - Phone:610-872-2643
Mailing Address - Street 1:4590 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1728
Mailing Address - Country:US
Mailing Address - Phone:610-872-2643
Mailing Address - Fax:
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:610-872-2643
Practice Address - Fax:610-872-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0691110001Medicare NSC