Provider Demographics
NPI:1003162280
Name:SHIMUNOV, ALEKSANDR (OPTITION)
Entity Type:Individual
Prefix:MR
First Name:ALEKSANDR
Middle Name:
Last Name:SHIMUNOV
Suffix:
Gender:M
Credentials:OPTITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 656766
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:917-204-6655
Mailing Address - Fax:917-819-3240
Practice Address - Street 1:1550 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1503
Practice Address - Country:US
Practice Address - Phone:917-204-6655
Practice Address - Fax:917-819-3240
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007474-1156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist