Individual
IRINA KOTOVSKY FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1042 SECOND AVE, LENSCRAFTERS INC,, NEW YORK, NY 10011
(212) 759-8150
Mailing address
3215 41ST ST APT D3, ASTORIA, NY 11103-3537
(646) 483-9165
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007075
NY
Other
Enumeration date
08/19/2006
Last updated
12/18/2008
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