Individual
MICHAEL KAKZANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7221 AUSTIN ST, FOREST HILLS, NY 11375-5354
(718) 268-4040
Mailing address
7221 AUSTIN ST, FOREST HILLS, NY 11375-5354
(718) 268-4040
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
006662
NY
152WS0006X
Sports Vision Optometrist
006662
NY
Other
Enumeration date
11/01/2006
Last updated
06/07/2021
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