Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 39515 | KY |
NPI | 1023128063 |
---|---|
Provider Name | Dr. Mark Cassol |
First Address | Louisville, KY 40206-1433 |
Second Address | Louisville, KY 40206-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |