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General NPI Number Information
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NPI Number | 1538246996
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Entity Type | Organization
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Legal Business Name | MISSION OPTICAL, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 18646 DIXIE HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-3715
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Country | US
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Telephone | 708-647-6635
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Fax | 708-647-6649
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Provider Business Mailing Address
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Address Line | 18646 DIXIE HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-3715
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Country | US
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Telephone | 708-647-6635
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Fax | 708-647-6649
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMMET MICHAEL CASSIDY
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Credential | M.D.
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Telephone | 708-647-6635
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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 |
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License Number State |
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