Provider Demographics
NPI:1891831079
Name:BRANDE SAAD GROUP-BEDFORD
Entity Type:Organization
Organization Name:BRANDE SAAD GROUP-BEDFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TERRITO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-623-2020
Mailing Address - Street 1:111 FAIRVIEW ST.
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-6337
Mailing Address - Country:US
Mailing Address - Phone:814-623-2020
Mailing Address - Fax:814-623-7816
Practice Address - Street 1:111 FAIRVIEW ST.
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6337
Practice Address - Country:US
Practice Address - Phone:814-623-2020
Practice Address - Fax:814-623-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011774900006Medicaid
PA1007346180003Medicaid
PA1007346180003Medicaid
PA0736660001Medicare NSC
566998EECMedicare ID - Type Unspecified