Individual
KAYGOSHTASB KAVOUSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
ROUTE 12 NORTH, RIVERSIDE MALL, PEARLE VISION, UTICA, NY 13502
(315) 000-0000
Mailing address
PO BOX 363, LAKEWOOD, NY 14750-0363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
02380
IA
152W00000X
Optometrist
0618001619
VA
152W00000X
Optometrist
2566
CO
152W00000X
Optometrist
63558749934
UT
152W00000X
Optometrist
OD-619
HI
152W00000X
Optometrist
OD00003937
WA
152W00000X
Optometrist
ODP-100127
ID
152W00000X
Optometrist
OET009046
PA
152W00000X
Optometrist
OPT12719-TPA
CA
152W00000X
Optometrist
Primary
TUV007112-1
NY
Other
Enumeration date
12/22/2006
Last updated
12/11/2009
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