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General NPI Number Information
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NPI Number | 1760897383
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Entity Type | Individual
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Provider Name | ROMAN S KAKZANOV OD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 119-15 ATLANTIC AVENUE
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City | RICHMOND HILL
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State | NY
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Zip | 11418
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Country | US
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Telephone | 718-805-0700
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Fax | 718-805-5621
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Provider Business Mailing Address
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Address Line | 105-24 64RD FOREST HILLS APT 2S
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City | NY
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State | NY
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Zip | 11375
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Country | US
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Telephone | 917-476-7757
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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 | TUV008183-1
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License Number State | NY
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