Basic Information
| Provider Information | |||||||||
| NPI: | 1326086018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DALE | ||||||||
| FirstName: | BRANDYE | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DALE-PISACANO | ||||||||
| OtherFirstName: | BRANDYE | ||||||||
| OtherMiddleName: | LYN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9602 DUNDERRY HTS | ||||||||
| Address2: | |||||||||
| City: | BALDWINSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130279082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157203989 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1818 STATE ROUTE 3 | ||||||||
| Address2: | VISION CENTER | ||||||||
| City: | FULTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130691513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155981669 | ||||||||
| FaxNumber: | 3155981671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0006095 | NY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.