Provider Demographics
NPI:1528245248
Name:SACCO-BROWN OPTOMETRY P. C.
Entity type:Organization
Organization Name:SACCO-BROWN OPTOMETRY P. C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SACCO-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-828-8733
Mailing Address - Street 1:183 HEALY BLVD
Mailing Address - Street 2:CORNER PLAZA
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1509
Mailing Address - Country:US
Mailing Address - Phone:518-828-8733
Mailing Address - Fax:518-828-4898
Practice Address - Street 1:183 HEALY BLVD
Practice Address - Street 2:CORNER PLAZA
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1509
Practice Address - Country:US
Practice Address - Phone:518-828-8733
Practice Address - Fax:518-828-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004816332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01952923Medicaid
NY01952923Medicaid