Provider Demographics
NPI:1164522645
Name:LAKOVITSKY, DIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:LAKOVITSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:LYAKHOVITSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1644 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1144
Mailing Address - Country:US
Mailing Address - Phone:646-642-3292
Mailing Address - Fax:718-633-0554
Practice Address - Street 1:4818 13TH AVE
Practice Address - Street 2:KLEINS VISION CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3111
Practice Address - Country:US
Practice Address - Phone:718-633-5162
Practice Address - Fax:718-633-0554
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02557977Medicaid
NY02557977Medicaid
NYV00317Medicare UPIN