Individual
TANYA MIKITCHENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
328B SPARTA AVE, SPARTA, NJ 07871-1167
(973) 604-2020
Mailing address
328B SPARTA AVE, SPARTA, NJ 07871-1167
(973) 604-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
008131
NY
152W00000X
Optometrist
Primary
27OA00710300
NJ
Other
Enumeration date
06/05/2014
Last updated
12/28/2021
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