Provider Demographics
NPI:1487103255
Name:CASSIS, ANDREW (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CASSIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 49TH ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1909
Mailing Address - Country:US
Mailing Address - Phone:304-925-3937
Mailing Address - Fax:304-925-4336
Practice Address - Street 1:301 49TH ST SE STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1909
Practice Address - Country:US
Practice Address - Phone:304-925-3937
Practice Address - Fax:304-925-4336
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2026-IOD1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist