Provider Demographics
NPI:1700821048
Name:BOLBIRER, VICTORIA (OD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BOLBIRER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORBIN PL APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4938
Mailing Address - Country:US
Mailing Address - Phone:917-327-6903
Mailing Address - Fax:
Practice Address - Street 1:1721 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5303
Practice Address - Country:US
Practice Address - Phone:332-322-2020
Practice Address - Fax:323-322-1010
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02378343Medicaid
NYC67271Medicare PIN
NYC67271Medicare ID - Type UnspecifiedPROVIDER
NY02378343Medicaid