Provider Demographics
NPI:1992856314
Name:KOGANOVSKY, STEVEN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
Last Name:KOGANOVSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N STATE ROAD 7
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4500
Mailing Address - Country:US
Mailing Address - Phone:954-972-6934
Mailing Address - Fax:954-972-6946
Practice Address - Street 1:101 N STATE ROAD 7
Practice Address - Street 2:SUITE 103
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4500
Practice Address - Country:US
Practice Address - Phone:954-972-6934
Practice Address - Fax:954-972-6946
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOPC1231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19074AMedicare ID - Type Unspecified
FLT93854Medicare UPIN