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General NPI Number Information
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NPI Number | 1154486090
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Entity Type | Individual
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Provider Name | KAYGOSHTASB KAVOUSI OD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | ROUTE 12 NORTH RIVERSIDE MALL, PEARLE VISION
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City | UTICA
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State | NY
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Zip | 13502
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Country | US
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Telephone | 315-000-0000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 363
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City | LAKEWOOD
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State | NY
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Zip | 14750-0363
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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 | TUV007112-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001619
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OET009046
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02380
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2566
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License Number State | CO
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100127
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License Number State | ID
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Taxonomy #7
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 63558749934
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License Number State | UT
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Taxonomy #8
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD-619
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License Number State | HI
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Taxonomy #9
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003937
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License Number State | WA
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Taxonomy #10
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT12719-TPA
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License Number State | CA
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