Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC3908 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC3908 | FL |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OPC3908 | FL |
N | 152WS0006X | Sports Vision | OPC3908 | FL |
N | 152WV0400X | Optomitrist - Vision Therapist | OPC3908 | FL |
N | 152WX0102X | Occupational Vision | OPC3908 | FL |
NPI | 1164448569 |
---|---|
Provider Name | Dr. Marina Kotlyar |
First Address | Bronx, NY 10475-4614 |
Second Address | Bronx, NY 10475-4614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 18/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
621051100 | (05) | FL |
V07384 | (02) | FL |