MEDICARE: DR. BELLA DAVYDOV O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV007990	NY
2	152W00000X	Optometrist	007990	NY

General Provider Information

NPI Number	:	1093156820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BELLA DAVYDOV O.D.

Provider Business Mailing Address
First Line	:	14345 HOOVER AVE
Second Line	:
City	:	BRIARWOOD
State	:	NY
Zip	:	11435-2137
Country	:	US
Telephone Number	:	718-887-4987
Fax Number	:

Provider Business Practice Location Address
First Line	:	10023 QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2452
Country	:	US
Telephone Number	:	718-997-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	04/02/2025

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