MEDICARE: OPTOMETRIC PRACTICE OF DR. MICHAEL J. CASSANO, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046.008556	IL

General Provider Information

NPI Number	:	1265593172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTOMETRIC PRACTICE OF DR. MICHAEL J. CASSANO, P.C.

Provider Business Mailing Address
First Line	:	608 S WASHINGTON ST
Second Line	:	SUITE 306
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6663
Country	:	US
Telephone Number	:	630-718-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 S WASHINGTON ST
Second Line	:	SUITE 306
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6663
Country	:	US
Telephone Number	:	630-718-1031
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL JOHN CASSANO
Credential	:	O.D.
Telephone Number	:	630-718-1031

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/12/2014

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