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General NPI Number Information
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NPI Number | 1225195431
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Entity Type | Organization
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Legal Business Name | STEPHAN CASSIDY OD PS
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 450 NW GILMAN BLVD STE 104
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-392-8756
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Fax | 425-391-8631
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Provider Business Mailing Address
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Address Line | 450 NW GILMAN BLVD STE 104
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-392-8756
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Fax | 425-391-8631
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHAN L. CASSIDY
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Credential | OD
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Telephone | 425-392-8756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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