Provider Demographics
NPI:1700542446
Name:AMINOV, VYACHESLAV
Entity Type:Individual
Prefix:
First Name:VYACHESLAV
Middle Name:
Last Name:AMINOV
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 1:1 CVS DRIVE
Mailing Address - Street 2:MAIL STOP #3005
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:413-770-2286
Mailing Address - Fax:401-269-4731
Practice Address - Street 1:309 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5714
Practice Address - Country:US
Practice Address - Phone:914-654-8603
Practice Address - Fax:914-235-6085
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008182156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician