Provider Demographics
NPI:1760641674
Name:NATALIA RAEVA OD PC
Entity Type:Organization
Organization Name:NATALIA RAEVA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-414-6490
Mailing Address - Street 1:1203 RIVER RD APT 16D
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1465
Mailing Address - Country:US
Mailing Address - Phone:201-414-6490
Mailing Address - Fax:201-886-2160
Practice Address - Street 1:32-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4616
Practice Address - Country:US
Practice Address - Phone:201-414-6490
Practice Address - Fax:201-886-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00576500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty