Healthcare Provider Details

I. General information

NPI: 1871763607
Provider Name (Legal Business Name): DEMETRA HAMAKIOTES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 E 84TH ST GROUND FLOOR
NEW YORK NY
10028-2000
US

IV. Provider business mailing address

171 E 84TH ST GROUND FLOOR
NEW YORK NY
10028-2000
US

V. Phone/Fax

Practice location:
  • Phone: 212-717-1500
  • Fax: 212-717-1482
Mailing address:
  • Phone: 212-717-1500
  • Fax: 212-717-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberVUT005198
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberVUT005198
License Number StateNY

VIII. Authorized Official

Name: DR. DEMETRA HAMAKIOTES
Title or Position: OWNER
Credential: O.D.
Phone: 212-717-1500