Provider Demographics
NPI:1043454010
Name:AMINOVA, SVELTANA (OPTICIAN)
Entity type:Individual
Prefix:
First Name:SVELTANA
Middle Name:
Last Name:AMINOVA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1501
Mailing Address - Country:US
Mailing Address - Phone:718-261-2344
Mailing Address - Fax:718-261-3356
Practice Address - Street 1:12430 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1501
Practice Address - Country:US
Practice Address - Phone:718-261-2344
Practice Address - Fax:718-261-3356
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007438156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician