Provider Demographics
NPI:1750357406
Name:JAMES A CASAZZA
Entity type:Organization
Organization Name:JAMES A CASAZZA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-475-5252
Mailing Address - Street 1:15 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3708
Mailing Address - Country:US
Mailing Address - Phone:978-475-5252
Mailing Address - Fax:978-475-2226
Practice Address - Street 1:15 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3708
Practice Address - Country:US
Practice Address - Phone:978-475-5252
Practice Address - Fax:978-475-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0327182Medicaid
MAW15206OtherBLUE CROSS BLUE SHIELD
MA0326370001Medicare NSC
MAT90905Medicare UPIN
MA0327182Medicaid