MEDICARE: DR. NICOLETTE J SACCO-BROWN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	TUV 4816	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10001777	OTHER	NY	CDPHP
2	597417	OTHER	NY	MVP HEALTHPLAN

General Provider Information

NPI Number	:	1790874097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLETTE J SACCO-BROWN OD

Provider Business Mailing Address
First Line	:	183 HEALY BLVD
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1509
Country	:	US
Telephone Number	:	518-828-8733
Fax Number	:	518-828-4898

Provider Business Practice Location Address
First Line	:	183 HEALY BLVD
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1509
Country	:	US
Telephone Number	:	518-828-8733
Fax Number	:	518-828-4898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/27/2007

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