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General NPI Number Information
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NPI Number | 1033604517
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Entity Type | Individual
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Provider Name | GAUHAR KANIMETOVA OD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 457 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-5107
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Country | US
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Telephone | 718-386-0021
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Fax | 718-386-0023
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Provider Business Mailing Address
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Address Line | 52 CANAL ST APT 4B
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City | NEW YORK
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State | NY
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Zip | 10002-6134
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Country | US
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Telephone |
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 008766
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License Number State | NY
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