Individual
ELIZABETH YUSUPOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3130 GRAND CONCOURSE, STE 1J, BRONX, NY 10458-1213
(718) 741-3200
Mailing address
6360 102ND ST, APT E7, REGO PARK, NY 11374-2451
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008499
NY
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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