Basic Information
| Provider Information | |||||||||
| NPI: | 1649590431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUKENIK | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | TABAKMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3405 MIDWAY RD STE 421 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728012727 | ||||||||
| FaxNumber: | 9729433485 | ||||||||
| Practice Location | |||||||||
| Address1: | 3405 MIDWAY RD STE 421 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728012727 | ||||||||
| FaxNumber: | 9729433485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 08/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7841T | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 7841TG | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.