Healthcare Provider Details

I. General information

NPI: 1639590128
Provider Name (Legal Business Name): SEZANI & CO. OPTICIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 6TH AVE
NEW YORK NY
10018-0169
US

IV. Provider business mailing address

1006 6TH AVE
NEW YORK NY
10018-0169
US

V. Phone/Fax

Practice location:
  • Phone: 212-764-6133
  • Fax: 212-764-6136
Mailing address:
  • Phone: 212-764-6133
  • Fax: 212-764-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number00053991
License Number StateNY

VIII. Authorized Official

Name: MRS. BETTY KIMYAGAROVA
Title or Position: OPTICIAN/MANAGER
Credential:
Phone: 212-764-6133