Provider Demographics
NPI:1093156820
Name:DAVYDOV, BELLA (OD)
Entity type:Individual
Prefix:DR
First Name:BELLA
Middle Name:
Last Name:DAVYDOV
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14345 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2137
Mailing Address - Country:US
Mailing Address - Phone:718-887-4987
Mailing Address - Fax:
Practice Address - Street 1:10023 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2452
Practice Address - Country:US
Practice Address - Phone:718-997-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007990152W00000X
NY007990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist