| Doctor Name: | ROMAN RAKHIMOV |
| NPI Number: | 1023229481 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OPT |
| License Number: | 007325 |
| Business Practice Address: | 224 Sunrise Mall Massapequa, NY - 117584340 |
| Business Phone Number: | 5167953030 |
| Business Fax Number: | |
| Mailing Address: | 143-26 84 Th Rd, JAMAICA |
| State: | NY |
| Postal Code: | 11435 |
| Phone Number: | 7182620410 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2007 |
| NPI Last Update Date: | 11/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 007325 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |