=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558539726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G & L CASSEL LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2008
-----------------------------------------------------
Last Update Date | 10/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8415 BELLONA LANE SUITE 104
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-828-9270
-----------------------------------------------------
Fax | 410-321-0124
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8415 BELLONA LANE SUITE 104
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-828-9270
-----------------------------------------------------
Fax | 410-321-0124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GARY H CASSEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 410-828-9270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 06755568
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------