Provider Demographics
NPI:1194013946
Name:MENEZES, LUANA LIVIA (OD)
Entity type:Individual
Prefix:DR
First Name:LUANA
Middle Name:LIVIA
Last Name:MENEZES
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 1:3080 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4242
Mailing Address - Country:US
Mailing Address - Phone:718-873-9550
Mailing Address - Fax:718-228-4591
Practice Address - Street 1:3080 21ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4242
Practice Address - Country:US
Practice Address - Phone:718-873-9550
Practice Address - Fax:718-228-4591
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist