Organization
MISSION OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMET MICHAEL CASSIDY M.D. (OWNER)
(708) 647-6635
Entity
Organization
Contact information
Practice address
18646 DIXIE HWY, HOMEWOOD, IL 60430-3715
(708) 647-6635
(708) 647-6649
Mailing address
18646 DIXIE HWY, HOMEWOOD, IL 60430-3715
(708) 647-6635
(708) 647-6649
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092971
—
IL
01
—
5249450001
DMERC
IL
01
—
DF6134
MEDICARE RAILROAD
IL
Enumeration date
11/01/2006
Last updated
07/07/2008
Update your record
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