Provider Demographics
NPI:1093777377
Name:BOORAS, KONSTANTINOS (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:
Last Name:BOORAS
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 NORTHERN BLVD
Mailing Address - Street 2:STE 313
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5101
Mailing Address - Country:US
Mailing Address - Phone:516-472-7310
Mailing Address - Fax:516-368-3862
Practice Address - Street 1:505 NORTHERN BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5115
Practice Address - Country:US
Practice Address - Phone:516-472-7310
Practice Address - Fax:516-368-3862
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006759152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management