Provider Demographics
NPI:1790874097
Name:SACCO-BROWN, NICOLETTE J (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:J
Last Name:SACCO-BROWN
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 1:183 HEALY BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1509
Mailing Address - Country:US
Mailing Address - Phone:518-828-8733
Mailing Address - Fax:518-828-4898
Practice Address - Street 1:183 HEALY BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1509
Practice Address - Country:US
Practice Address - Phone:518-828-8733
Practice Address - Fax:518-828-4898
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 4816152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001777OtherCDPHP
NY597417OtherMVP HEALTHPLAN
NY597417OtherMVP HEALTHPLAN