Provider Demographics
NPI:1245274620
Name:POWELL, BRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HOOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3400
Mailing Address - Country:US
Mailing Address - Phone:845-896-2427
Mailing Address - Fax:
Practice Address - Street 1:969 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1791
Practice Address - Country:US
Practice Address - Phone:845-896-6700
Practice Address - Fax:845-896-6882
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
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NY000412569001OtherHEALTHNOW OF N.Y.
NY390887OtherM V P
NYC480C1OtherEMPIRE BC/BS
NY10118806OtherC D P H P
NY1343583OtherAETNA HEALTH INSURANCE
NY161526023OtherPOMCO
NYP3704610OtherOXFORD HEALTH INSURANCE
NY1166630001Medicare NSC