MEDICARE: RADMILA ILYAYEVA

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	007755	NY

General Provider Information

NPI Number	:	1790067817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADMILA ILYAYEVA

Provider Business Mailing Address
First Line	:	455 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4707
Country	:	US
Telephone Number	:	718-238-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4707
Country	:	US
Telephone Number	:	718-238-3296
Fax Number	:

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	05/27/2016

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Directions to “ RADMILA ILYAYEVA ” Practice Location

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