Provider Demographics
NPI:1972856292
Name:VERONICA KHAIMOV OD PC
Entity Type:Organization
Organization Name:VERONICA KHAIMOV OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-975-5631
Mailing Address - Street 1:14432 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1327
Mailing Address - Country:US
Mailing Address - Phone:917-975-5631
Mailing Address - Fax:718-544-1048
Practice Address - Street 1:14432 68TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1327
Practice Address - Country:US
Practice Address - Phone:917-975-5631
Practice Address - Fax:718-544-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty