Provider Demographics
NPI:1881732246
Name:BRANDON, LINDA CAROL (OD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:BRANDON
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 1:7 ANN DR
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-2245
Mailing Address - Country:US
Mailing Address - Phone:845-876-6699
Mailing Address - Fax:
Practice Address - Street 1:601 FRANK SOTTILE BLVD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1550
Practice Address - Country:US
Practice Address - Phone:845-336-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTOO5209-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA900043393Medicare PIN