Provider Demographics
NPI:1609939784
Name:BASILE, BELISA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:BELISA
Middle Name:ANN
Last Name:BASILE
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 1:8 CENTER SQUARE
Mailing Address - Street 2:
Mailing Address - City:E LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028
Mailing Address - Country:US
Mailing Address - Phone:413-525-1766
Mailing Address - Fax:413-525-1766
Practice Address - Street 1:8 CENTER SQUARE
Practice Address - Street 2:
Practice Address - City:E LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-525-2900
Practice Address - Fax:413-525-2900
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA043006404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3171OtherEYEMED
MA0354031Medicaid
701146OtherCONNECTICARE
10464OtherHEALTH NEW ENGLAND
MA43006404OtherCIGNA
765665OtherTUFTS
14703OtherSPECTERA
765665OtherSECURE HORIZONS
151420OtherHARVARD PILGRIM
MAW15737OtherBCBS
MAW15737OtherBCBS
MA3171OtherEYEMED