Provider Demographics
NPI:1952587495
Name:BELISA A. BASILE, OD
Entity Type:Organization
Organization Name:BELISA A. BASILE, OD
Other - Org Name:DR. BASILE A. BASILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-525-2900
Mailing Address - Street 1:8 CENTER SQ
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2402
Mailing Address - Country:US
Mailing Address - Phone:413-525-2900
Mailing Address - Fax:413-525-2900
Practice Address - Street 1:8 CENTER SQ
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2402
Practice Address - Country:US
Practice Address - Phone:413-525-2900
Practice Address - Fax:413-525-2900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALISA A. BASILE, OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1098060001Medicare NSC