Provider Demographics
NPI:1225231350
Name:MILORD, MARIE LYVIE (O,D,)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LYVIE
Last Name:MILORD
Suffix:
Gender:F
Credentials:O,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TRAFALGAR SQ
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3135
Mailing Address - Country:US
Mailing Address - Phone:516-887-2013
Mailing Address - Fax:718-284-9344
Practice Address - Street 1:2307 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5407
Practice Address - Country:US
Practice Address - Phone:718-826-5063
Practice Address - Fax:718-284-9344
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01746309Medicaid
NY01746309Medicaid
NYC452C1Medicare ID - Type Unspecified