Provider Demographics
NPI:1679120927
Name:SHIMUNOV, YULIYA (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MS
First Name:YULIYA
Middle Name:
Last Name:SHIMUNOV
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1929
Mailing Address - Country:US
Mailing Address - Phone:718-418-0100
Mailing Address - Fax:718-418-0005
Practice Address - Street 1:6240 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1929
Practice Address - Country:US
Practice Address - Phone:718-418-0100
Practice Address - Fax:718-418-0005
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007920-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician