Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | VUT 6255-1 | NY |
NPI | 1003963992 |
---|---|
Provider Name | Svetlana Katanov |
First Address | Rego Park, NY 11374-5032 |
Second Address | Forest Hills, NY 11375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02645590 | (05) | NY |