Provider Demographics
NPI:1700821048
Name:BOLBIRER, VICTORIA (OD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BOLBIRER
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 1:1524 SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2319
Mailing Address - Country:US
Mailing Address - Phone:917-416-1411
Mailing Address - Fax:
Practice Address - Street 1:1150 SOUTH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3404
Practice Address - Country:US
Practice Address - Phone:718-761-2973
Practice Address - Fax:718-761-3089
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02378343Medicaid
NYC67271Medicare PIN
NYC67271Medicare ID - Type UnspecifiedPROVIDER
NY02378343Medicaid