Provider Demographics
NPI:1003444811
Name:BRUNELL SOUTHDOWN OPTICAINS, INC.
Entity Type:Organization
Organization Name:BRUNELL SOUTHDOWN OPTICAINS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRUNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-271-0550
Mailing Address - Street 1:210 WALL ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2092
Mailing Address - Country:US
Mailing Address - Phone:631-271-0550
Mailing Address - Fax:
Practice Address - Street 1:210 WALL ST UNIT A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2092
Practice Address - Country:US
Practice Address - Phone:631-271-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty