Individual
JACOB DAVIDOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
9309 63RD DR # A, REGO PARK, NY 11374-2924
(718) 275-0955
(718) 275-3725
Mailing address
9309 63RD DR # A, REGO PARK, NY 11374-2924
(718) 275-0955
(718) 275-3725
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
006154-1
NY
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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