Organization
LEADING OPTOMETRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANA ILYASOVA O.D. (OPTOMETRIST)
(646) 209-3384
Entity
Organization
Contact information
Practice address
7511 169TH ST, FRESH MEADOWS, NY 11366-1337
(646) 209-3384
Mailing address
7511 169TH ST, FRESH MEADOWS, NY 11366-1337
(646) 209-3384
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007417
NY
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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