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General NPI Number Information
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NPI Number | 1003071200
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Entity Type | Organization
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Legal Business Name | MARK CASSOL MD PSC
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 2600 W. BROADWAY, SUITE 105
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City | LOUISVILLE
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State | KY
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Zip | 40211
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Country | US
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Telephone | 502-772-3625
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8073
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City | LOUISVILLE
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State | KY
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Zip | 40257
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Country | US
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Telephone | 502-759-2765
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Fax |
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | MARK CASSOL
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Credential | MD
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Telephone | 502-759-2765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 39515
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License Number State | KY
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