Provider Demographics
NPI:1932103439
Name:CASPER, JAMIE J (OD, PHD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:J
Last Name:CASPER
Suffix:
Gender:M
Credentials:OD, PHD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2606
Mailing Address - Country:US
Mailing Address - Phone:910-452-7225
Mailing Address - Fax:910-452-7229
Practice Address - Street 1:5526 CAROLINA BEACH RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2606
Practice Address - Country:US
Practice Address - Phone:910-452-7225
Practice Address - Fax:910-452-7229
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5463152W00000X
NC1946152WP0200X, 152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901590Medicaid
NC5901590Medicaid
NC2473736Medicare PIN