Provider Demographics
NPI:1730873597
Name:VAIDYA, RAJ (OD)
Entity type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 170TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1823
Mailing Address - Country:US
Mailing Address - Phone:929-260-9982
Mailing Address - Fax:
Practice Address - Street 1:16413 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4913
Practice Address - Country:US
Practice Address - Phone:929-218-7155
Practice Address - Fax:929-218-7157
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist