Provider Demographics
NPI:1154570836
Name:BRANDY, HEATHER WHITE (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:WHITE
Last Name:BRANDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:STE 235
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3213
Mailing Address - Country:US
Mailing Address - Phone:650-259-0300
Mailing Address - Fax:
Practice Address - Street 1:645 RODI RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4564
Practice Address - Country:US
Practice Address - Phone:412-256-2020
Practice Address - Fax:412-247-4963
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-002135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149114TYRMedicare PIN