Provider Demographics
NPI:1003883505
Name:SHARIVKER, ISAAK (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:ISAAK
Middle Name:
Last Name:SHARIVKER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6344
Mailing Address - Country:US
Mailing Address - Phone:718-261-1764
Mailing Address - Fax:718-261-1764
Practice Address - Street 1:11212 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6344
Practice Address - Country:US
Practice Address - Phone:718-261-1764
Practice Address - Fax:718-261-1764
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006712-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9724462OtherGHI
NY010047901OtherAMERICHOICE
NY230230OtherUNITED HEALTHCARE
NY905828OtherBLOCK VISION
NY2960956OtherAETNA
NY168520OtherEYE MED VISION CARE
NY01788816Medicaid
NYP3871801OtherOXFORD HEALTH PLANS
NY905828OtherBLOCK VISION
NY230230OtherUNITED HEALTHCARE
NY01788816Medicaid