Provider Demographics
NPI:1760525513
Name:DAVID DALESSANDRO OD PA
Entity Type:Organization
Organization Name:DAVID DALESSANDRO OD PA
Other - Org Name:AMAZING EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-653-5626
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-890-9044
Mailing Address - Fax:973-890-9054
Practice Address - Street 1:64 SIP AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3134
Practice Address - Country:US
Practice Address - Phone:201-653-5626
Practice Address - Fax:201-222-3960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID DALESSANDRO OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ5363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0108219Medicaid
NJ0108219Medicaid
NJU57078Medicare UPIN
NJ5772340001Medicare NSC
NJ114031Medicare PIN