Provider Demographics
NPI:1447583828
Name:KAGAN, VLADISLAV
Entity Type:Individual
Prefix:MR
First Name:VLADISLAV
Middle Name:
Last Name:KAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 SURF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1129
Mailing Address - Country:US
Mailing Address - Phone:718-496-5906
Mailing Address - Fax:718-636-4505
Practice Address - Street 1:83 5TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4654
Practice Address - Country:US
Practice Address - Phone:718-636-4526
Practice Address - Fax:718-636-4505
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008614156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician