Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV008522-1 | NY |
NPI | 1013466275 |
---|---|
Provider Name | Nadezhda Kalantarova |
First Address | Flushing, NY 11367-3140 |
Second Address | Flushing, NY 11367-3140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 29/09/2016 |