Provider Demographics
NPI:1881897429
Name:CASEY & CASEY INC
Entity type:Organization
Organization Name:CASEY & CASEY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-375-9170
Mailing Address - Street 1:3128 WALTON BLVD
Mailing Address - Street 2:PMB 225
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1265
Mailing Address - Country:US
Mailing Address - Phone:248-375-9170
Mailing Address - Fax:248-375-2892
Practice Address - Street 1:3128 WALTON BLVD
Practice Address - Street 2:PMB 225
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1265
Practice Address - Country:US
Practice Address - Phone:248-375-9170
Practice Address - Fax:248-375-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3094815Medicaid
MI0N62070Medicare PIN
MI0M00190Medicare PIN
MI3094815Medicaid