Provider Demographics
NPI:1699591800
Name:VOLKOVA, LYUDMILA (LDO4779)
Entity type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:VOLKOVA
Suffix:
Gender:F
Credentials:LDO4779
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2300
Mailing Address - Country:US
Mailing Address - Phone:954-680-7835
Mailing Address - Fax:954-680-7842
Practice Address - Street 1:4700 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-2300
Practice Address - Country:US
Practice Address - Phone:954-680-7835
Practice Address - Fax:954-680-7842
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4779156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician