Provider Demographics
NPI:1285278606
Name:PURE EYECARE OPTOMETRY P.C.
Entity type:Organization
Organization Name:PURE EYECARE OPTOMETRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKZANOV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-476-7757
Mailing Address - Street 1:10537 65TH AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1818
Mailing Address - Country:US
Mailing Address - Phone:917-476-7757
Mailing Address - Fax:
Practice Address - Street 1:10537 65TH AVE APT 4D
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1818
Practice Address - Country:US
Practice Address - Phone:917-476-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty