Provider Demographics
NPI:1417976598
Name:KANEVSKY, VIOLA (OD)
Entity Type:Individual
Prefix:DR
First Name:VIOLA
Middle Name:
Last Name:KANEVSKY
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 1:527 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3402
Mailing Address - Country:US
Mailing Address - Phone:212-580-2020
Mailing Address - Fax:212-580-2023
Practice Address - Street 1:527 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3402
Practice Address - Country:US
Practice Address - Phone:212-580-2020
Practice Address - Fax:212-580-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005443152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC449D1OtherEMPIRE BCBS
NY5731500001OtherDMEPOS
NM11225933OtherCAQH NUMBER
NYC0A541Medicare PIN
NYC449D1OtherEMPIRE BCBS
NY5731500001Medicare NSC