Individual
AVA LOUISE KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
887 OLD COUNTRY RD STE G-KL, RIVERHEAD, NY 11901-2115
(631) 727-2858
Mailing address
44 ROOSEVELT ST, GLEN HEAD, NY 11545-1422
(516) 236-8538
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
009217
NY
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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