Provider Demographics
NPI:1992120299
Name:SUYUNOV, AVI (OPT)
Entity type:Individual
Prefix:MR
First Name:AVI
Middle Name:
Last Name:SUYUNOV
Suffix:
Gender:M
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3112
Mailing Address - Country:US
Mailing Address - Phone:347-533-6050
Mailing Address - Fax:347-533-6051
Practice Address - Street 1:4803 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3112
Practice Address - Country:US
Practice Address - Phone:347-533-6050
Practice Address - Fax:347-533-6051
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-23
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008339156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician