Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 008965 | NY |
NPI | 1003478009 |
---|---|
Provider Name | Dr. Michelle Yudina |
First Address | Brooklyn, NY 11235-6677 |
Second Address | Brooklyn, NY 11229-1904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2019 |
Last Update Date | 01/07/2019 |