Provider Demographics
NPI:1053798637
Name:CASSIN, KEVIN (OD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CASSIN
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 1:2019 JEFFERSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3258
Mailing Address - Country:US
Mailing Address - Phone:507-645-9202
Mailing Address - Fax:507-645-9203
Practice Address - Street 1:2019 JEFFERSON RD STE A
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-645-9202
Practice Address - Fax:507-645-9203
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400222255Medicare PIN