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General NPI Number Information
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NPI Number | 1093738437
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Entity Type | Organization
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Legal Business Name | HALIKIOPOULOS OPHTHALMOLOGY, PC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 NORTHERN BLVD SUITE 205
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City | GREAT NECK
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State | NY
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Zip | 11021-4309
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Country | US
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Telephone | 516-466-4670
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Fax | 516-466-4675
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Provider Business Mailing Address
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Address Line | 107 NORTHERN BLVD SUITE 205
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City | GREAT NECK
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State | NY
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Zip | 11021-4309
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Country | US
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Telephone | 516-466-4670
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Fax | 516-466-4675
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Authorized Official
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Title or Position | OWNER
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Name | DEMETRIOS HALIKIOPOULOS
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Credential | DO
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Telephone | 516-466-4670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 217146
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License Number State | NY
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