Provider Demographics
NPI:1013984186
Name:CASSIS, NATHALIE
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:
Last Name:CASSIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2112
Mailing Address - Country:US
Mailing Address - Phone:757-622-3937
Mailing Address - Fax:757-596-6947
Practice Address - Street 1:335 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2112
Practice Address - Country:US
Practice Address - Phone:757-622-3937
Practice Address - Fax:757-596-6947
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010047480Medicaid
VAC08955Medicare PIN
VAU72183Medicare UPIN