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General NPI Number Information
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NPI Number | 1497255236
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Entity Type | Organization
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Legal Business Name | CASSIE MARK LLC
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 42 LANGLEY RD
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City | NEWTON
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State | MA
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Zip | 02459-1918
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Country | US
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Telephone | 617-869-8464
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Fax |
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Provider Business Mailing Address
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Address Line | 42 LANGLEY RD
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City | NEWTON
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State | MA
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Zip | 02459-1918
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Country | US
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Telephone | 617-431-5747
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CASSANDRA L MARK
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Credential | OD
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Telephone | 617-431-5747
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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 | 5229
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License Number State | MA
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