Healthcare Provider Details

I. General information

NPI: 1013235373
Provider Name (Legal Business Name): MILAN OPTIQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 5 AVE
BROOKLYN NY
11217
US

IV. Provider business mailing address

83 5 AVE
BROOKLYN NY
11217
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-4526
  • Fax: 718-636-4505
Mailing address:
  • Phone: 718-636-4526
  • Fax: 718-636-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MILANA DOSTOVA
Title or Position: PRESIDENT
Credential:
Phone: 917-957-8838