Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 34343 | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 34343 | CA |
NPI | 1285283275 |
---|---|
Provider Name | Dr. Ilya Nikolai Volk |
First Address | Encinitas, CA 92024-1332 |
Second Address | Encinitas, CA 92024-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 03/10/2019 |