Provider Demographics
NPI:1396114542
Name:ASTOLIN, SHIFRA (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:SHIFRA
Middle Name:
Last Name:ASTOLIN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1584
Mailing Address - Country:US
Mailing Address - Phone:718-484-3760
Mailing Address - Fax:718-484-3761
Practice Address - Street 1:803 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1584
Practice Address - Country:US
Practice Address - Phone:718-484-3760
Practice Address - Fax:718-484-3761
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009504156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009504OtherOPTICIAN LICENSE