=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235458761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J CASPER, O.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2010
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E MAIN ST
-----------------------------------------------------
City | DWIGHT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60420-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-584-5148
-----------------------------------------------------
Fax | 815-828-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E MAIN ST # 151
-----------------------------------------------------
City | DWIGHT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60420-1320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-584-5148
-----------------------------------------------------
Fax | 815-828-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. DAVID J CASPER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 815-744-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046007155
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------