Provider Demographics
NPI:1750343943
Name:CASSAR, KEVIN S (OD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:S
Last Name:CASSAR
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:70 E LAKEWOOD BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2695
Mailing Address - Country:US
Mailing Address - Phone:616-395-2662
Mailing Address - Fax:616-395-2992
Practice Address - Street 1:70 E LAKEWOOD BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2695
Practice Address - Country:US
Practice Address - Phone:616-395-2662
Practice Address - Fax:616-395-2992
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2007-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004262152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01932Medicare UPIN