Individual
MR. ILYA DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
324 ATLANTIC AVE, BROOKLYN, NY 11201-5852
(718) 624-6700
(718) 624-6701
Mailing address
324 ATLANTIC AVE, BROOKLYN, NY 11201-5852
(718) 624-6700
(718) 624-6701
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
0088961
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760727101
BUSINESS NPI
NY
Enumeration date
01/10/2013
Last updated
01/10/2013
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