Provider Demographics
NPI:1306893144
Name:CASS, PETER J (OD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CASS
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 1:6725 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7655
Mailing Address - Country:US
Mailing Address - Phone:409-832-4136
Mailing Address - Fax:409-835-3623
Practice Address - Street 1:6725 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7655
Practice Address - Country:US
Practice Address - Phone:409-832-4136
Practice Address - Fax:409-835-3623
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9298701005OtherCIGNA
TX80921QOtherBLUECROSSBLUESHIELD OF TX
TX148312502Medicaid
TX7775479OtherAETNA
TX8F23739Medicare PIN
TX9298701005OtherCIGNA
TX148312502Medicaid
TX80921QOtherBLUECROSSBLUESHIELD OF TX