Individual
IZICK KHANIMOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
115 7TH AVE, BROOKLYN, NY 11215-1301
(718) 398-2020
(718) 230-0024
Mailing address
115 7TH AVE, BROOKLYN, NY 11215-1301
(718) 398-2020
(718) 230-0024
Taxonomy
Speciality
Code
Description
License number
State
156FX1101X
Ophthalmic Assistant
Primary
00897-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008970-1
OPTICIAN
NY
Enumeration date
01/14/2021
Last updated
01/14/2021
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