Provider Demographics
NPI:1447326129
Name:SHAPIRO, BRION STUART (LIC OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:BRION
Middle Name:STUART
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:LIC OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2808
Mailing Address - Country:US
Mailing Address - Phone:845-485-4080
Mailing Address - Fax:845-485-4175
Practice Address - Street 1:76 FULTON AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2808
Practice Address - Country:US
Practice Address - Phone:845-485-4080
Practice Address - Fax:845-485-4175
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4985156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0433980001Medicare ID - Type Unspecified