Healthcare Provider Details

I. General information

NPI: 1487182010
Provider Name (Legal Business Name): CASSANDRA LYNNE MARK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LANGLEY RD
NEWTON MA
02459-1918
US

IV. Provider business mailing address

42 LANGLEY RD
NEWTON MA
02459-1918
US

V. Phone/Fax

Practice location:
  • Phone: 617-431-5747
  • Fax: 617-431-5747
Mailing address:
  • Phone: 617-431-5747
  • Fax: 617-431-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5229
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: