MEDICARE: GALINA NIYAZOV O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV008170	NY

General Provider Information

NPI Number	:	1316352370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALINA NIYAZOV O.D.

Provider Business Mailing Address
First Line	:	1305 E 18TH ST APT 4E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5330
Country	:	US
Telephone Number	:	718-431-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	6373 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1607
Country	:	US
Telephone Number	:	718-896-2020
Fax Number	:	718-459-3490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	01/04/2019

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