Provider Demographics
NPI:1487834859
Name:BRANDYWINE OPTICAL INC
Entity Type:Organization
Organization Name:BRANDYWINE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-479-9455
Mailing Address - Street 1:3606 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-5191
Mailing Address - Country:US
Mailing Address - Phone:302-479-9455
Mailing Address - Fax:302-479-5349
Practice Address - Street 1:3606 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5191
Practice Address - Country:US
Practice Address - Phone:302-479-9455
Practice Address - Fax:302-479-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989016780332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0705990001Medicare NSC