Provider Demographics
NPI:1053447904
Name:KHAIMOV, VERONICA (OD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:KHAIMOV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14432 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1327
Mailing Address - Country:US
Mailing Address - Phone:917-975-5631
Mailing Address - Fax:
Practice Address - Street 1:14432 68TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1327
Practice Address - Country:US
Practice Address - Phone:917-975-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist