Provider Demographics
NPI:1699751511
Name:SHAKIR, SALVATORE JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:JOHN
Last Name:SHAKIR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4639
Mailing Address - Country:US
Mailing Address - Phone:718-513-6911
Mailing Address - Fax:718-513-6912
Practice Address - Street 1:2922 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4639
Practice Address - Country:US
Practice Address - Phone:718-758-2020
Practice Address - Fax:718-513-6912
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003585-1152W00000X
NYTUV003585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00844073Medicaid
NY0126190001Medicare NSC
NYT48970Medicare UPIN