Provider Demographics
NPI:1780947267
Name:OLGA KOTLYAR, OD, PLLC
Entity type:Organization
Organization Name:OLGA KOTLYAR, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTLYAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-515-5626
Mailing Address - Street 1:10902 BRAES BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1809
Mailing Address - Country:US
Mailing Address - Phone:713-515-5626
Mailing Address - Fax:281-890-9938
Practice Address - Street 1:103 YALE STREET
Practice Address - Street 2:SUITE 100 B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007
Practice Address - Country:US
Practice Address - Phone:713-515-5626
Practice Address - Fax:281-890-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6443TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU97745Medicare UPIN