MEDICARE: DR. MICHAEL JOHN CASSANO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046.008556	IL
2	152W00000X	Optometrist	346.000642	IL

General Provider Information

NPI Number	:	1730138801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN CASSANO O.D.

Provider Business Mailing Address
First Line	:	2239 KENYON CT
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-1392
Country	:	US
Telephone Number	:	630-701-2441
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 S WASHINGTON ST
Second Line	:	SUITE 306
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6663
Country	:	US
Telephone Number	:	630-718-1031
Fax Number	:	630-718-1039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	09/12/2014

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