Provider Demographics
NPI:1073712675
Name:BUKHATETSKY, ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:BUKHATETSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4807
Mailing Address - Country:US
Mailing Address - Phone:718-768-1020
Mailing Address - Fax:718-768-1050
Practice Address - Street 1:519 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4807
Practice Address - Country:US
Practice Address - Phone:718-768-1020
Practice Address - Fax:718-768-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02892506Medicaid
NYCRR351Medicare PIN