Provider Demographics
NPI:1437338266
Name:SAIDEL, ROBERT N (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:SAIDEL
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 1:181 E MAIN ST
Mailing Address - Street 2:PO BOX 326
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1552
Mailing Address - Country:US
Mailing Address - Phone:315-287-1644
Mailing Address - Fax:315-287-4419
Practice Address - Street 1:181 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1552
Practice Address - Country:US
Practice Address - Phone:315-287-1644
Practice Address - Fax:315-287-4419
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003785152W00000X
NYP017003785332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00624002Medicaid
NYT26515Medicare UPIN
NY00624002Medicaid