Provider Demographics
NPI:1386647154
Name:PISELLO, DAWN LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:LOUISE
Last Name:PISELLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1157
Mailing Address - Country:US
Mailing Address - Phone:585-924-4430
Mailing Address - Fax:
Practice Address - Street 1:325 WEST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1723
Practice Address - Country:US
Practice Address - Phone:585-394-2020
Practice Address - Fax:585-394-9261
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01627430Medicaid
NY11094IMedicare PIN
NYU46573Medicare UPIN