Provider Demographics
NPI:1063571008
Name:PROEKTOR, LYUDMILA (ABO-NCLE)
Entity type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:PROEKTOR
Suffix:
Gender:F
Credentials:ABO-NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 ROMAINE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6325
Mailing Address - Country:US
Mailing Address - Phone:323-650-5949
Mailing Address - Fax:
Practice Address - Street 1:6336 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3155
Practice Address - Country:US
Practice Address - Phone:323-934-0099
Practice Address - Fax:323-934-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB4624156FC0800X
CA43911156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX006939FMedicaid