Provider Demographics
NPI:1851939441
Name:DANIEL RAFAELOV OD P.C.
Entity Type:Organization
Organization Name:DANIEL RAFAELOV OD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAELOV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:347-200-7716
Mailing Address - Street 1:41 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2515
Mailing Address - Country:US
Mailing Address - Phone:718-858-5000
Mailing Address - Fax:
Practice Address - Street 1:340 JAY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2930
Practice Address - Country:US
Practice Address - Phone:718-858-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty