Izick Khanimov, OPTICIAN

Primary specialty

Ophthalmic AssistantTaxonomy code 156FX1101X

License

00897-01 Issued in NY

Practice address

115 7TH Ave
Brooklyn, NY 11215-1301

Phone

(718) 398-2020

Fax

(718) 230-0024

NPI assigned

Jan 14, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Izick Khanimov Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Eyecare Inc

  • Optometrist
  • Brooklyn, NY
  • NPI 1700599784
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1013506948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 7TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112151301",
            "telephone_number": "718-398-2020",
            "fax_number": "718-230-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 7TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112151301",
            "telephone_number": "718-398-2020",
            "fax_number": "718-230-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANIMOV",
        "first_name": "IZICK",
        "credential": "OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-14",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1101X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ophthalmic Assistant",
            "state": "NY",
            "license": "00897-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICIAN",
            "identifier": "008970-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IZICK",
            "last_name": "KHANIMOV",
            "credential": "OPTICIAN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Carolyn Rebecca Khanian, PHD
• Dilyara Khanieva
• Pradeep K Khanijou, DDS
• Rita Khanijou, MD
• Emmanuel Khanimov
• Vlada Khanimov
• Yuriy Khanimov
• Aleksandr Khanin, DPT
• Margarita Khanina, LCSW
• Genadi Khanis, LMT

• Technician/Technologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Technician/Technologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.