Provider Demographics
NPI:1427133362
Name:KROKOFF, MYRA S (OD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:S
Last Name:KROKOFF
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 1:3253 PERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4233
Mailing Address - Country:US
Mailing Address - Phone:516-536-9411
Mailing Address - Fax:
Practice Address - Street 1:46 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1104
Practice Address - Country:US
Practice Address - Phone:516-791-5300
Practice Address - Fax:516-791-5391
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV4793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT81506Medicare UPIN
NYC37071Medicare ID - Type Unspecified