Provider Demographics
NPI:1679636153
Name:DECKER, NATASHA (OD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:DECKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:HAKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:274 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1157
Mailing Address - Country:US
Mailing Address - Phone:585-924-4430
Mailing Address - Fax:
Practice Address - Street 1:274 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1157
Practice Address - Country:US
Practice Address - Phone:585-924-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist