Provider Demographics
NPI:1992298558
Name:SHEMTOVOV, LIOR (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:
First Name:LIOR
Middle Name:
Last Name:SHEMTOVOV
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2132
Mailing Address - Country:US
Mailing Address - Phone:646-671-0616
Mailing Address - Fax:347-909-7893
Practice Address - Street 1:7217 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2132
Practice Address - Country:US
Practice Address - Phone:646-671-0616
Practice Address - Fax:347-909-7893
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009623-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician