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General NPI Number Information
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NPI Number | 1013506948
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Entity Type | Individual
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Provider Name | IZICK KHANIMOV OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 115 7TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-1301
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Country | US
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Telephone | 718-398-2020
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Fax | 718-230-0024
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Provider Business Mailing Address
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Address Line | 115 7TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-1301
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Country | US
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Telephone | 718-398-2020
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Fax | 718-230-0024
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number | 00897-01
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License Number State | NY
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