Provider Demographics
NPI:1144296286
Name:CASSEDAY, ADAM W (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:W
Last Name:CASSEDAY
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:304-335-6158
Practice Address - Street 1:US ROUTES 219 250
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:304-335-6158
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1027-OD152W00000X, 152WL0500X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005257Medicaid
WV1027-ODOtherOPTOMETRIST
WV3001226OtherBRICK STREET WORKERS COMP
WVFQ01027OtherHEALTH PLAN
WVP00336360OtherRAILROAD MEDICARE
WV096270OtherAMERICAN OPTOMETRIC ASSOC
WVCA2027361Medicare PIN
WV3810005257Medicaid