MEDICARE: DR. CRAIG A CASSEY O.D.

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	OEG000453	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0110498000	OTHER	PA	INDEPENDENCE BLUE CROSS
2	513325	OTHER	PA	HIGHMARK
3	55515	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1669463535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG A CASSEY O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1008
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-0008
Country	:	US
Telephone Number	:	610-872-6077
Fax Number	:	610-872-2845

Provider Business Practice Location Address
First Line	:	4590 EDGMONT AVE
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-1728
Country	:	US
Telephone Number	:	610-872-6077
Fax Number	:	610-872-2845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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