Healthcare Provider Details

I. General information

NPI: 1144296286
Provider Name (Legal Business Name): ADAM W. CASSEDAY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ROUTES 219 250
MILL CREEK WV
26280
US

IV. Provider business mailing address

PO BOX 247
MILL CREEK WV
26280-0247
US

V. Phone/Fax

Practice location:
  • Phone: 304-335-2050
  • Fax: 304-335-6158
Mailing address:
  • Phone: 304-335-2050
  • Fax: 304-335-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1027-OD
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1027-OD
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1027-OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: