Provider Demographics
NPI:1033371976
Name:SEMCHENKOVA, OLESYA (OD)
Entity Type:Individual
Prefix:DR
First Name:OLESYA
Middle Name:
Last Name:SEMCHENKOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 E 23RD ST
Mailing Address - Street 2:APT # 1 G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2847
Mailing Address - Country:US
Mailing Address - Phone:917-607-3543
Mailing Address - Fax:
Practice Address - Street 1:503 DITMAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5001
Practice Address - Country:US
Practice Address - Phone:917-607-3543
Practice Address - Fax:347-221-1420
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007292-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400006945Medicare PIN