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General NPI Number Information
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NPI Number | 1619074200
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Entity Type | Individual
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Provider Name | VALENTIN RAKSIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 05/14/2016
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Provider Practice Location Address
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Address Line | 227 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701
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Country | US
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Telephone | 732-364-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 40 QUEBEC RD
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City | MARLBORO
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State | NJ
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Zip | 07746-1654
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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 | TUV006253-1
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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 | 27OA00578000
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License Number State | NJ
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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 | 27TO00123200
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License Number State | NJ
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