Provider Demographics
NPI:1841263555
Name:KOLLMAN, MEYER (OD)
Entity type:Individual
Prefix:DR
First Name:MEYER
Middle Name:
Last Name:KOLLMAN
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 1:1023 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2711
Mailing Address - Country:US
Mailing Address - Phone:718-826-1234
Mailing Address - Fax:
Practice Address - Street 1:1023 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2711
Practice Address - Country:US
Practice Address - Phone:718-826-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01159026Medicaid
NY01159026Medicaid
NYT81483Medicare UPIN
NYC30201Medicare PIN