Provider Demographics
NPI:1972728525
Name:NYCHKA, DIANA SOPHIA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:SOPHIA
Last Name:NYCHKA
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 1:10 OLD FIELD PL
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06853-1116
Mailing Address - Country:US
Mailing Address - Phone:203-956-7496
Mailing Address - Fax:
Practice Address - Street 1:93 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3203
Practice Address - Country:US
Practice Address - Phone:203-799-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT2635OtherSTATE LICENSE