Individual
LOGANNE TATJANA MIKKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
33 W 42ND ST, NEW YORK, NY 10036-8005
(212) 938-4000
Mailing address
33 W 42ND ST, NEW YORK, NY 10036-8005
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
011065
NY
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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