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General NPI Number Information
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NPI Number | 1679846521
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Entity Type | Organization
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Legal Business Name | MEDICAL EYE ASSOCIATES OF LOUISVILLE PSC
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 3999 DUTCHMANS LN SUITE 5F
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City | LOUISVILLE
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State | KY
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Zip | 40207-4729
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Country | US
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Telephone | 502-899-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 7840 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45236-4301
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Country | US
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Telephone | 513-354-5808
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MARK CASSOL
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Credential | M.D.
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Telephone | 502-759-2765
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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 | 39515
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License Number State | KY
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