Provider Demographics
NPI:1285966218
Name:BADE, ALICE (OD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:BADE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:NORTHEAST EYE CENTER SUITE 109
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-690-7020
Mailing Address - Fax:518-690-7022
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:NORTHEAST EYE CENTER SUITE 109
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-690-7020
Practice Address - Fax:518-690-7022
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400030167OtherMEDICARE NGS