Provider Demographics
NPI:1538299656
Name:BRUMAGHIM, DEAN (OD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:BRUMAGHIM
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 1:189 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-2510
Mailing Address - Country:US
Mailing Address - Phone:518-725-3513
Mailing Address - Fax:
Practice Address - Street 1:189 2ND AVE
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-2510
Practice Address - Country:US
Practice Address - Phone:518-725-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008209-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0820170001OtherSENIOR BLUE
NY0820170001Medicare NSC