Provider Demographics
NPI:1609506328
Name:HAIDATOV OPTOMETRY PC
Entity Type:Organization
Organization Name:HAIDATOV OPTOMETRY PC
Other - Org Name:OAKLAND GARDENS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDATOV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-483-6624
Mailing Address - Street 1:21519 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2928
Mailing Address - Country:US
Mailing Address - Phone:718-483-6624
Mailing Address - Fax:
Practice Address - Street 1:21519 73RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2928
Practice Address - Country:US
Practice Address - Phone:718-483-6624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty