Provider Demographics
NPI:1750305736
Name:BUDICK, DEBRA R (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:BUDICK
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 1:170 E 79TH ST
Mailing Address - Street 2:APT. 8B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0436
Mailing Address - Country:US
Mailing Address - Phone:212-737-5446
Mailing Address - Fax:212-737-5531
Practice Address - Street 1:LIGHTHOUSE INTERNATIONAL, 111 EAST 59TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1202
Practice Address - Country:US
Practice Address - Phone:212-821-9645
Practice Address - Fax:212-821-9710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT003846-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU10235Medicare UPIN
NYDB0C432510Medicare ID - Type UnspecifiedEMPIRE MEDICARE NUMBER