Provider Demographics
NPI:1063852986
Name:ZILNICKI, MIKI LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:MIKI
Middle Name:LYN
Last Name:ZILNICKI
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 1:25 CRANBERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2762
Mailing Address - Country:US
Mailing Address - Phone:631-740-9384
Mailing Address - Fax:631-740-9385
Practice Address - Street 1:25 CRANBERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2762
Practice Address - Country:US
Practice Address - Phone:631-740-9384
Practice Address - Fax:631-740-9385
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007991-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400131250Medicare PIN