Provider Demographics
NPI:1326086018
Name:DALE, BRANDYE LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDYE
Middle Name:LYN
Last Name:DALE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRANDYE
Other - Middle Name:LYN
Other - Last Name:DALE-PISACANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:9602 DUNDERRY HTS
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9082
Mailing Address - Country:US
Mailing Address - Phone:315-720-3989
Mailing Address - Fax:
Practice Address - Street 1:1818 STATE ROUTE 3
Practice Address - Street 2:VISION CENTER
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1513
Practice Address - Country:US
Practice Address - Phone:315-598-1669
Practice Address - Fax:315-598-1671
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0006095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU81260Medicare UPIN
NJ040288ABHMedicare ID - Type Unspecified