Provider Demographics
NPI:1053973115
Name:PALAVETS, TATSIANA (OD)
Entity type:Individual
Prefix:DR
First Name:TATSIANA
Middle Name:
Last Name:PALAVETS
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 1:2400 E 3RD ST APT 327
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5302
Mailing Address - Country:US
Mailing Address - Phone:917-690-0561
Mailing Address - Fax:
Practice Address - Street 1:629 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3354
Practice Address - Country:US
Practice Address - Phone:718-708-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty