MEDICARE: JACOB DAVIDOV LICENSED OPTICIAN

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	156FX1800X	Optician	006154-1	NY

General Provider Information

NPI Number	:	1932239191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB DAVIDOV LICENSED OPTICIAN

Provider Business Mailing Address
First Line	:	9309 63RD DR # A
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2924
Country	:	US
Telephone Number	:	718-275-0955
Fax Number	:	718-275-3725

Provider Business Practice Location Address
First Line	:	9309 63RD DR # A
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2924
Country	:	US
Telephone Number	:	718-275-0955
Fax Number	:	718-275-3725

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

Similar Medicare Providers

1023116050 — 63RD DRIVE PHARMACY CORP
Practice Location Address:

9305 63RD DR
REGO PARK, NY
11374-2924

Practice Phone: 718-459-3370
Practice Fax: 718-459-2074

1144301425 — SHELDON RETKINSKI
Practice Location Address:

9309 63RD DR
REGO PARK, NY
11374-2924

Practice Phone: 718-275-0955
Practice Fax:

1871761478 — DAVIDOFF OPTICAL CENTER CORP.
Practice Location Address:

9309 63RD DR
REGO PARK, NY
11374-2924

Practice Phone: 718-275-0955
Practice Fax: 718-275-3725

1588988950 — MR. SEMEN K ILIZAROV
Practice Location Address:

9305 63RD DR
REGO PARK, NY
11374-2924

Practice Phone: 718-459-3370
Practice Fax: 718-459-2074

1962839019 — NEIGHBORHOOD DRUGSTORE INC.
Practice Location Address:

9305 63RD DR
REGO PARK, NY
11374-2924

Practice Phone: 718-997-6900
Practice Fax: 718-997-6901

1184108581 — ALL HEALTH PRODUCTS INC.
Practice Location Address:

9305 63RD DR
REGO PARK, NY
11374-2924

Practice Phone: 718-997-6900
Practice Fax: 718-997-6901

Directions to “ JACOB DAVIDOV LICENSED OPTICIAN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.