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General NPI Number Information
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NPI Number | 1841535218
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Entity Type | Individual
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Provider Name | BORIS TAKHALOV OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 111 HEMPSTEAD TPKE INSIDE NWL
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-2155
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Country | US
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Telephone | 516-493-9323
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Fax |
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Provider Business Mailing Address
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Address Line | 40 N FRANKLIN ST INSIDE NWL
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City | HEMPSTEAD
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State | NY
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Zip | 11550-2155
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Country | US
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Telephone | 516-493-9323
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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 | 156FX1700X
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Taxonomy Name | Ocularist
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License Number | 009414-1
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License Number State | NY
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