Individual
DR. IVA BASIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4141 51ST ST, WOODSIDE, NY 11377-4431
(718) 505-0100
Mailing address
4141 51ST ST, WOODSIDE, NY 11377-4431
(718) 505-0100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
008227
NY
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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