Provider Demographics
NPI:1114074945
Name:DENEVE, EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:DENEVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BELLPORT LN
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 BELLPORT LN
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2705
Practice Address - Country:US
Practice Address - Phone:631-286-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6097TUV152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY864OtherSTORE
NY66599326OtherPROVIDER
NY50593OtherPROVIDER
NY7182561OtherPROVIDER
NYV73OtherSTORE
NY157939OtherPROVIDER
NY163OtherPROVIDER
NY7182561OtherPROVIDER