Provider Demographics
NPI:1558349894
Name:BRANDOW, SHEILA DUDA (OD)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:DUDA
Last Name:BRANDOW
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 1:28001 SCHOENHERR RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4396
Mailing Address - Country:US
Mailing Address - Phone:586-756-5060
Mailing Address - Fax:586-756-9783
Practice Address - Street 1:28001 SCHOENHERR RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4396
Practice Address - Country:US
Practice Address - Phone:586-756-5060
Practice Address - Fax:586-756-9783
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3304799Medicaid
MIOM94630Medicare ID - Type Unspecified
U67062Medicare UPIN