Individual
OLGA SHIMANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9102 63 DR, REGO PARK, NY 11374-3850
(718) 897-5101
Mailing address
9961 65RD, REGO PARK, NY 11374-3850
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
007240-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02181708
—
NY
01
—
11554176
CAQH
NY
01
—
NY7240
EYE MED
NY
Enumeration date
10/17/2006
Last updated
06/02/2008
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