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General NPI Number Information
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NPI Number | 1801323209
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Entity Type | Organization
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Legal Business Name | MILLENIA VISION CORP
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 469 W 125TH ST
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City | NEW YORK
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State | NY
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Zip | 10027-4201
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Country | US
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Telephone | 646-767-1951
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Fax |
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Provider Business Mailing Address
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Address Line | 469 W 125TH ST
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City | NEW YORK
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State | NY
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Zip | 10027-4201
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Country | US
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Telephone | 646-767-1951
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN YAKUBOV
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Credential |
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Telephone | 646-767-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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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 | TUV008217
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License Number State | NY
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