Healthcare Provider Details

I. General information

NPI: 1881314755
Provider Name (Legal Business Name): ANASTASIYA ZAGURSKAYA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

6101 IMPERATA ST NE APT 1522
ALBUQUERQUE NM
87111-8022
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 347-705-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0003819
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: