Provider Demographics
NPI:1750487419
Name:GOULIAK, LIANA (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MRS
First Name:LIANA
Middle Name:
Last Name:GOULIAK
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25923 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1248
Mailing Address - Country:US
Mailing Address - Phone:718-347-7470
Mailing Address - Fax:718-347-7493
Practice Address - Street 1:25923 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1248
Practice Address - Country:US
Practice Address - Phone:718-347-7470
Practice Address - Fax:718-347-7493
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008418-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician