Provider Demographics
NPI:1306582176
Name:CASELLA, JONAH GAGE
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:GAGE
Last Name:CASELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-6010
Mailing Address - Country:US
Mailing Address - Phone:724-954-7090
Mailing Address - Fax:
Practice Address - Street 1:2020 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8354
Practice Address - Country:US
Practice Address - Phone:610-258-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist