Provider Demographics
NPI:1639481518
Name:BRANDYWINE VISION ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BRANDYWINE VISION ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-237-8760
Mailing Address - Street 1:808 TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4128
Mailing Address - Country:US
Mailing Address - Phone:484-237-8760
Mailing Address - Fax:610-495-2013
Practice Address - Street 1:410 W LINFIELD TRAPPE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-4295
Practice Address - Country:US
Practice Address - Phone:215-882-0013
Practice Address - Fax:610-495-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001141152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty