Individual
DR. ROMAN S KAKZANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
119-15 ATLANTIC AVENUE, RICHMOND HILL, NY 11418
(718) 805-0700
(718) 805-5621
Mailing address
105-24 64RD FOREST HILLS APT 2S, NY, NY 11375
(917) 476-7757
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008183-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03966603
—
NY
Enumeration date
06/23/2014
Last updated
09/20/2018
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