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General NPI Number Information
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NPI Number | 1972689255
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Entity Type | Individual
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Provider Name | ELIZA YAGHOUBIAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/28/2006
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 33 W 42ND ST
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City | NEW YORK
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State | NY
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Zip | 10036-8005
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Country | US
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Telephone | 212-938-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 60 WILLOW PARK CTR APT #3F
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City | FARMINGDALE
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State | NY
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Zip | 11735-1001
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Country | US
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Telephone | 646-431-4400
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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 | 007105
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License Number State | NY
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