Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV0081191 | NY |
NPI | 1013323302 |
---|---|
Provider Name | Gregori Osherov |
First Address | New York, NY 10036-8005 |
Second Address | New York, NY 10036-8005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 07/07/2014 |