Healthcare Provider Details

I. General information

NPI: 1447298062
Provider Name (Legal Business Name): THE BRANDE SAAD GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E CALDER WAY
STATE COLLEGE PA
16801-5663
US

IV. Provider business mailing address

421 E CALDER WAY
STATE COLLEGE PA
16801-5663
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-6060
  • Fax: 814-234-0797
Mailing address:
  • Phone: 814-234-6060
  • Fax: 814-234-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD JAY CERVINO
Title or Position: OPTOMETRIC DOCTOR
Credential: OD
Phone: 814-234-6060