Healthcare Provider Details

I. General information

NPI: 1417396912
Provider Name (Legal Business Name): DHIMITER LLAMBIRI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 HEMPSTEAD TPKE
LEVITTOWN NY
11756-1303
US

IV. Provider business mailing address

10 HEARTHSTONE CT
FARMINGDALE NY
11735-3654
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-9604
  • Fax:
Mailing address:
  • Phone: 347-216-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number56007968
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number56007968
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number56007968
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56007968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: