Provider Demographics
NPI:1023068913
Name:BASH, VLADIMIR
Entity type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:BASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13207 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2001
Mailing Address - Country:US
Mailing Address - Phone:718-357-4511
Mailing Address - Fax:
Practice Address - Street 1:13207 14TH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2001
Practice Address - Country:US
Practice Address - Phone:718-357-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008502156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY4302OtherEYEMED
NY15416OtherSPECTERA
NY330771OtherNVA
NY02334912Medicaid
NY49779OtherDAVIS VISION
NY973NOtherNATIONAL OPTICAL SERVICES
NY45572001Medicare ID - Type UnspecifiedCMS MADECARE
NY49779OtherDAVIS VISION