Provider Demographics
NPI:1811309230
Name:PIERSON, KASEY LEE (MD)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LEE
Last Name:PIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 PAPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1100
Mailing Address - Country:US
Mailing Address - Phone:610-372-0712
Mailing Address - Fax:610-376-6968
Practice Address - Street 1:1802 PAPERMILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1100
Practice Address - Country:US
Practice Address - Phone:610-372-0712
Practice Address - Fax:610-376-6968
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.133314207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277035Medicaid