Individual
DR. INNA ILYASOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
731 LYDIG AVE, BRONX, NY 10462-2103
(718) 829-2160
Mailing address
7739 169TH ST, FRESH MEADOWS, NY 11366-1307
(917) 254-0847
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
009470
NY
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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